Personal choices that might reduce lung cancer risk are explored in
2 articles in this issue of JAMA. First, Schabath
and colleaguesArticle examined the relationship between
dietary intake of phytoestrogens and lung cancer risk in a case-control study.
Their results suggest that higher phytoestrogen intake is associated with
a lower risk of lung cancer, particularly among never and current smokers.
In a second article, Godtfredsen and colleaguesArticle assessed
the effects of smoking reduction on lung cancer incidence in a population-based
cohort. They found that compared with continued heavy smokers (≥15 cigarettes/d),
persons who reported a 50% reduction in tobacco consumption between baseline
and a follow-up examination had a significantly reduced risk of lung cancer
over a mean follow-up of 18 years. In an editorial, Dacey and JohnstoneArticle summarize the study findings and emphasize the importance
of smoking cessation to reduce lung cancer risk.
Minor head trauma rarely results in intracranial injury, but identifying
the few patients who are injured is critically important. Two articles in
this issue of JAMA compare and validate the clinical
performance of 2 decision instruments that guide the use of cranial computed
tomography (CT) for minor head injury—the Canadian CT Head Rule (CCHR)
and the New Orleans Criteria (NOC). The investigators in both studiesArticleArticle found that the CCHR
and NOC had similar sensitivities (100%) for patients needing neurosurgical
intervention. A greater number of patients with any intracranial injury were
identified using the NOC. However, the CCHR had higher specificity for important
clinical outcomes, and its application could lower CT use and health care
costs. In an editorial, HaydelArticle discusses the
use of clinical decision instruments in the assessment of patients with traumatic
Previous data support an association between polymorphisms of the β1- and β2-adrenergic receptors (ADRB1 and ADRB2) and response to β-adrenergic
blocker therapy. Lanfear and colleagues investigated the effect of 4 common ADRB1 and ADRB2 gene variants
on survival of patients receiving β-blocker therapy after an acute coronary
syndrome (ACS). They found a significant association of the ADRB2 genotype with an increased risk of 3-year mortality among patients
prescribed β-blockers after ACS. No increased mortality risk was observed
in patients with the same ADRB2 gene variants who
were not prescribed β-blockers.
Rubenstein and colleagues summarize the new Department of Defense Medical
Program Principles and Procedures for the Protection and Treatment of Detainees
in the Custody of the Armed Forces of the United States (DoD guidelines) and
contrast these with principles of ethics for physicians and other health professionals
developed by the United Nations. They found that the DoD guidelines allow
participation of physicians in coercive interrogation practices prohibited
by international human rights law, the Geneva Convention, domestic law, and
professional codes of ethics.
Scientists predict that a new technique for producing human embryonic
stem cells by reprogramming adult cells will yield clues to the processes
that underlie stem cell development and provide a new tool for studying diseases.
Assessment and management of laryngopharyngeal reflux.
Factors associated with sunscreen use are examined in 2 articles published
in the Archives of Dermatology. Robinson discusses
the studies’ results and reinforces the importance of counseling patients
to limit UV light exposure.
For your patients: Information about head injury.
This Week in JAMA . JAMA. 2005;294(12):1463. doi:10.1001/jama.294.12.1463