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.
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.
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.
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.
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.
Sex and gender factors in medical research, health, and health care.
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.
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.
Mello and coauthors discuss whether use of direct-to-consumer advertising
of prescription drugs should result in greater tort liability for drug manufacturers.
For your patients: Sex and gender differences in health issues and medical
This Week in JAMA. JAMA. 2003;289(4):387. doi:10.1001/jama.289.4.387