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This Week in JAMA
January 22/29, 2003

This Week in JAMA

JAMA. 2003;289(4):387. doi:10.1001/jama.289.4.387
Early Cannabis Use and Risk of Other Drug Use

Several studies suggest that early cannabis use is a significant risk factor for other drug use and drug-related problems. Lynskey and colleaguesArticle analyzed data from a large community sample of young adult Australian monozygotic and dizygotic twins to examine whether the association between early cannabis use and subsequent progression to use of other drugs and drug-related problems persists after controlling for genetic and shared environmental influences. Individuals who used cannabis before age 17 years had significantly higher odds of other drug use, alcohol dependence, and other drug abuse/dependence than did their co-twins who did not report early cannabis use. In an editorial, KandelArticle discusses research strategies for determining the causal role of prior drug use on the subsequent use of other drug classes and considers policy implications of the gateway hypothesis.

Use of Organized Care Management Processes

Organized care management processes have been shown to improve the quality of care for patients with chronic diseases. Their use has been advocated by the Institute of Medicine and others to address deficiencies in the quality of health care in the United States. In this national cross-sectional survey of physician organizations with 20 or more physicians, Casalino and colleagues found that the mean use of care management processes was low and varied greatly. External incentives and clinical information technology systems were associated with increased care management process use.

Changes in Physician Career Satisfaction

During the past decade, the organization and management of medical practice has changed considerably. To examine trends in physician career satisfaction and how changes in the practice environment may affect changes in physician satisfaction, Landon and colleagues conducted telephone surveys of a nationally representative sample of physicians at 60 US sites in 1996-1997, 1998-1999, and 2000-2001. Overall physician satisfaction levels declined marginally between 1997 and 2001, with most of the decline occurring between 1997 and 1999. Physician satisfaction varied markedly among sites. Constraints on physicians' clinical autonomy were most strongly associated with changes in satisfaction.

Trends in Food Portion Sizes in the United States

Nielsen and Popkin analyzed dietary intake data from a series of nationally representative surveys of individuals aged 2 years or older to determine trends in food portion sizes consumed in the United States and compare portion sizes eaten inside and outside the home. Between 1977 and 1996, food portion sizes increased for most foods selected for the survey. Portion sizes were generally largest at fast-food locations and smallest at restaurants.

Clinician's corner

Mrs J is a 59-year-old woman with gastroesophageal reflux disease (GERD) and Barrett esophagus whose symptoms are currently well controlled with omeprazole. She has been receiving annual endoscopies to detect dysplasia. Spechler discusses the epidemiology of GERD, the evaluation and medical and surgical treatments of GERD, and management recommendations for patients with Barrett esophagus.

Contempo Updates

Sex and gender factors in medical research, health, and health care.

Medical News & Perspectives

Burgeoning growth of 2 hospital-related endeavors—the increase in specialty hospitals and the growth of the hospitalist discipline—has created many concerns as well as new careers for US physicians.

Conflicts of Interest in Biomedical Research

This systematic review of studies containing original, quantitative data on financial relationships among industry, scientific investigators, and academic institutions indicates that industry ties are widespread and appear to be associated with pro-industry study conclusions and restrictions on publication and data sharing.

Liability in Direct-to Consumer Advertising

Mello and coauthors discuss whether use of direct-to-consumer advertising of prescription drugs should result in greater tort liability for drug manufacturers.

JAMA Patient Page

For your patients: Sex and gender differences in health issues and medical research.