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This Week in JAMA
April 18, 2001

This Week in JAMA

JAMA. 2001;285(15):1927. doi:10.1001/jama.285.15.1927
Alcohol Consumption and Cardiovascular Disease

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.

St John's Wort for Treatment of Major Depression

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 studies. 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.

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CONSORT and Quality of Randomized Trial Reports

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.

Blinding Terminology in Randomized Controlled Trials

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.

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A Piece of My Mind

"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."

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Medical News & Perspectives

The Epidemic Intelligence Service of the Centers for Disease Control and Prevention, an elite corps of disease detectives, celebrates 50 years of medical sleuthing.

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CONSORT Revised

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

Controversies

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.

JAMA Patient Page

For your patients: Information about heart disease and alcohol use.

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