Observational studies have shown that individuals who consume alcohol
in light to moderate amounts have a lower risk of acute myocardial infarction
(MI) compared with individuals who abstain from alcohol or who are heavy drinkers.
Little is known, however, about the relationship between alcohol consumption
and mortality after acute MI or the development of heart failure independent
of MI. In a prospective cohort study of early survivors of acute MI, Mukamal
and colleaguesArticle found that compared with no alcohol intake, moderate alcohol
consumption in the year before MI was associated with reduced all-cause and
cardiovascular mortality after MI. Abramson and colleaguesArticle , in a prospective
study of community-based persons aged 65 years and older, found that low to
moderate alcohol consumption in the month prior to baseline was associated
with a lower risk of heart failure compared with no alcohol intake. In an
editorial, KlatskyArticle discusses factors to consider when advising patients with
heart disease about alcohol intake.
Results of previous clinical trials have indicated that St John's wort
is an effective and safe treatment for depression, but recent reviews have
identified major methodological flaws in these
In this 8-week randomized controlled trial, Shelton and colleagues compared
the efficacy and safety of a standardized extract of St John's wort with placebo
among outpatients with major depression. The rate of change in scores on the
Hamilton Rating Scale for Depression was not significantly different in the
2 treatment groups. The response rates in both groups were similar, and remission
rates were low, although significantly higher in the St John's wort group.
The Consolidated Standards of Reporting Trials (CONSORT) statement,
published in 1996, included a checklist with specific items considered essential
to unbiased reporting and accurate interpretation of a randomized controlled
trial (RCT) and a proposed diagram to present the flow of study participants
through the trial. Moher and colleaguesArticle evaluated the quality of RCT reports
before (1994) and after (1998) publication of the CONSORT statement using
a sample of RCTs published in 3 journals that adopted the CONSORT statement
and in a fourth journal that did not adopt the CONSORT statement. Compared
with 1994, the number of CONSORT checklist items included in RCT reports increased
in all 4 journals in 1998, and overall report quality scores improved in 3
of the 4 journals; the frequency of unclear reporting of allocation concealment
decreased in all 4 journals. These changes in the quality of RCT reports were
statistically significant for the 3 journals as a group that adopted the CONSORT
statement. In an analysis of 270 RCT reports published in 1998 in 5 general
and internal medicine journals, Egger and colleaguesArticle found that about half
included flow diagrams. Publication of a flow diagram was associated with
overall completeness of reporting about flow of study participants.
The terms "single," "double," and "triple" blind are used in reports
of randomized controlled trials (RCTs) to indicate the blinding status of
individuals involved in the study. Devereaux and colleagues surveyed internal
medicine physicians at 3 university health centers to determine which of 6
possible groups (participants, health care providers, data collectors, judicial
assessors of outcomes, data analysts, or writers) they thought were blinded
in single-, double-, and triple-blind RCTs and reviewed definitions of blinding
in 25 textbooks. Physicians varied greatly in their interpretations of blinding
terms as did textbook definitions.
"Without availing ourselves of the inspiration that wisdom sources foster,
followed by recommitment and action, we will stay where we are, settling for
less than what our patients, our loved ones, and we deserve." From "Lost in
a Dark Wood: How Wisdom Sources Can Light the Way."
The Epidemic Intelligence Service of the Centers for Disease Control
and Prevention, an elite corps of disease detectives, celebrates 50 years
of medical sleuthing.
The revised version of the Consolidated Standards of Reporting Trials
(CONSORT) statementArticle, originally developed to improve the quality of reports
of randomized trials, includes a modified 22-item checklist and flow diagram
template based on new evidence and experience with the original standards.Article
To clearly separate continuing medical education (CME) programs from
pharmaceutical marketing activities, RelmanArticle asserts that pharmaceutical companies
should not participate in CME except, perhaps, by providing unrestricted financial
support. HolmerArticle maintains that the pharmaceutical industry is a critical source
of funding for CME and reviews current guidelines that are intended to help
ensure that industry-supported CME is nonpromotional.
For your patients: Information about heart disease and alcohol use.
This Week in JAMA . JAMA. 2001;285(15):1927. doi:10.1001/jama.285.15.1927