Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed
for the treatment of depression. Kroenke and colleaguesArticle compared the effectiveness
of initial treatment with 3 SSRIs—paroxetine, fluoxetine, and sertraline—in
a randomized trial among patients beginning antidepressant therapy in primary
care practices. During 9 months of follow-up, amelioration of depression and
improvements in other psychological, functional, and health-related quality-of-life
outcomes were not significantly different among the 3 treatment groups. In
an editorial, SimonArticle discusses selection of first-line antidepressant medication
and care after the initial prescription, noting that initial treatment with
any SSRI drug will not be successful in a substantial minority of patients.
Inflammatory mediators are released from basophils and mast cells when
IgE bound to these cells is cross-linked by specific allergens. Omalizumab,
a recombinant humanized monoclonal anti-IgE antibody, blocks binding of IgE
to inflammatory cells. In this randomized trial, Casale and colleaguesArticle found
that patients with ragweed-induced seasonal allergic rhinitis who received
omalizumab, 300 mg for 3 or 4 treatments beginning just prior to the ragweed
season, experienced less severe nasal symptoms, used less rescue antihistamine,
and had better rhinitis-specific quality of life during the ragweed season
compared with patients who received placebo. In an editorial, PlautArticle describes
the effects of omalizumab on IgE pathways and discusses other potential immune-based
therapies for allergic diseases.
Young children are often asymptomatic when infected with hepatitis A
virus (HAV) and may play an important role in HAV transmission. Averhoff and
colleagues report that following the introduction of routine childhood hepatitis
A vaccination in Butte County, California, a large community that had experienced
recurrent outbreaks of HAV infection, the community-wide incidence of hepatitis
A declined markedly.
Evidence suggests that alcohol use is a risk factor for boating fatalities.
In this case-control study of alcohol use and recreational boating fatalities
in Maryland and North Carolina, Smith and colleagues found that the risk of
death associated with alcohol use increased with increasing blood alcohol
concentrations and was significantly increased even at a blood alcohol level
of 10 mg/dL.
Some patients with HIV infection appear to benefit from structured treatment
interruptions—repetitive on-and-off cycles of highly active antiretroviral
therapy (HAART)—as an alternative to continuous HAART. In this review
of recently published studies on STI, Lori and Lisziewicz evaluate the advantages
and potential risks of STI as a treatment option for patients infected with
Economic analyses that determine treatment cost-effectiveness generally
do not include estimates of costs and benefits of implementation methods to
influence treatment use in clinical practice. Mason and colleagues describe
a model for estimating the cost-effectiveness of methods to influence physician
behavior and apply the model to a recent trial of educational outreach by
community pharmacists to influence physician prescribing of angiotensin-converting
enzyme inhibitors and antidepressants.
"A process designed to evaluate my potential as a future colleague had
instead shown me a profession that appeared indifferent, demeaning, and horribly
out of touch. Did I really want to be a physician?" From "Welcome to the Process."
Thirty years after passage of the National Cancer Act, Samuel Broder,
MD, former National Cancer Institute director, reflects on successes and failures
of the war against cancer.
Two case studies—one of an African American couple and the other,
a Chinese American family—illustrate issues involved in cross-cultural
care at the end of life.
A medical model for increasing physician awareness of personal emotions
during the care of seriously ill patients.
For your patients: Information about seasonal allergic rhinitis.
This Week in JAMA. JAMA. 2001;286(23):2907. doi:10.1001/jama.286.23.2907