Two articles in this issue of THE JOURNAL examine how publication of
clinical trial results influence physician prescribing practices. In an analysis
of national trends in hormone therapy use from January 1995 through July 2003,
Hersh and colleaguesArticlefound that hormone therapy prescriptions
increased from 1995 to 1999, remained stable through June 2002, then declined
rapidly following publication of 2 trials in July 2002 that demonstrated increased
risk of cardiovascular disease and other adverse effects with oral estrogen
plus progestin therapy. Stafford and colleaguesArticleexamined
national use of α-blockers for hypertension treatment before and after
publication of a clinical trial of antihypertensive therapy in which the α-blocker
doxazosin arm was terminated early because of unfavorable results compared
with diuretics. Use of doxazosin and other α-blockers increased steadily
from 1996 through 1999, but then declined modestly after publication of the
early trial results. In an editorial,ArticleNaylor discusses
the complex interplay of factors that influence physician prescribing behavior.
Ziconotide blocks neurotransmission from primary nociceptive afferents
by selectively binding to N-type voltage-sensitive calcium channels on neurons.
Staats and colleagues conducted a randomized trial to test the effectiveness
of intrathecal ziconotide for treatment of pain refractory to conventional
treatment in patients with AIDS or end-stage cancer. Improvement in pain intensity
scores from baseline to the end of the initial 5- to 6-day titration phase
was significantly greater in the ziconotide group than in the placebo group.
Cancer screening has been widely promoted in the United States despite
evidence of potential harm associated with screening, such as false-positive
results and treatment for slow-growing cancers that would not cause problems
in a person's lifetime even if untreated. Schwartz and colleagues conducted
a national telephone survey of adults without a history of cancer to determine
the public's general beliefs about cancer screening and early cancer detection.
Most survey participants responded that routine cancer screening is almost
always a good idea and that finding cancer early saves lives. Among respondents
who had experienced a false-positive screening test result, more than 40%
described that experience as very scary, but almost all were glad they had
had the initial test. Two thirds of respondents stated they would want to
be tested for a cancer even if nothing could be done.
The use of high fractional inspired concentration of oxygen (FIO2) in the perioperative period has been reported to reduce surgical
site infection in selected patients. In this randomized trial in a heterogeneous
general surgery patient population, Pryor and colleagues found that the incidence
of surgical site infection in the first 14 days after surgery was significantly
higher in the group that received FIO2 of 0.80 during surgery and
for the first 2 hours after surgery than in the group that received FIO2of 0.35.
Over the past century, nursing homes and hospitals have increasingly
become the site of death. Teno and colleagues conducted a mortality follow-back
survey of family members of decedents to examine whether family members' perceptions
of the quality of end-of-life care differed by the last place of care. Overall,
family members reported high rates of unmet needs for symptom management,
physician communication, emotional support, and being treated with respect.
Family members of decedents who received care at home with hospice services
reported greater satisfaction with overall quality of care and fewer unmet
needs than did family members of decedents whose last setting of care was
a hospital, nursing home, or home with home nursing services.
"When the trial started on June 23, 2003, I was nervous but confident."
From "Winners and Losers."
At a first of its kind summit, federal officials unveiled a plan to
discover the causes of autism and to develop treatments for the increasingly
diagnosed disorder within 10 years.
Defining the professional obligations and public roles of physicians.
Effects of climate change on health.
Information for authors interested in submitting manuscripts for consideration
for publication in JAMA and updated instructions for manuscript preparation
Clarification of the reporting relationships between the editor-in-chief
of JAMA, the Journal Oversight Committee, and the AMA for editorial governance
Ethical issues in methods of medical student education.
For your patients: Information about prenatal care.
This Week in JAMA . JAMA. 2004;291(1):9. doi:10.1001/jama.291.1.9