Two articles in this issue of JAMA report results of the National Surgical Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) trial, in which 19 747 postmenopausal women at increased risk of breast cancer were randomly assigned to receive either tamoxifen (20 mg/d) or raloxifene (60 mg/d) for a maximum of 5 years. In the first article, Vogel and colleaguesArticle report the trial results for major clinical outcomes. The authors found raloxifene was as effective as tamoxifen in reducing the risk of invasive breast cancer, but women taking raloxifene had anonsignificant increased risk of noninvasive breast cancer. Raloxifene use was associated with fewer thromboembolic events and cataracts and had comparable rates of other cancers, fractures, ischemic heart disease, and stroke compared with tamoxifen. In the second article, Land and colleaguesArticle report the trial findings on patient-reported symptoms and quality of life. Specifically, self-reported physical and mental health declined modestly during the trial, but there were no differences between the tamoxifen and raloxifene groups. Women taking tamoxifen reported better sexual function, but more gynecological problems, vasomotor symptoms, leg cramps, and bladder control problems, whereas women taking raloxifene reported more musculoskeletal problems, dyspareunia, and weight gain. In an editorial, Gradishar and CellaArticle discuss the results of the STAR trial and their implications for women at high risk of breast cancer.
Statins have antioxidant activity, and oxidative stress has been postulated as a risk factor for age-related cataract. Klein and colleagues investigated the relationship of statins to incident cataracts in an observational, population-based study. At the 5-year follow-up, the authors found a reduced incidence of nuclear cataracts in statin users compared with nonusers. The incidence of cortical and posterior subcapsular cataracts did not differ in statin users vs nonusers.
Whether primary care physician participation in pharmaceutical company–sponsored clinical trials influences treatment patterns or drug preferences is not known. Andersen and colleaguesArticle report results of an observational study that compared physician practices conducting a pharmaceutical company–sponsored trial on asthma medicine with physician practices not involved in the trial (controls) and assessed the physicians' adherence to international asthma treatment recommendations and choice of asthma medications. The authors found comparable adherence to asthma treatment guidelines in trial-conducting and control practices. However, physician practices conducting the trial were more likely to use the company's drugs than control practices. In an editorial, Psaty and RennieArticle discuss company-sponsored trials, commercial interests, and research integrity.
Contrast-induced nephropathy accounts for 12% of cases of hospital-acquired acute renal failure. In a systematic review of the literature, Pannu and colleagues describe risk factors for contrast-induced nephropathy, provide evidence-based recommendations for patient management, and define priorities for future research.
“As time has passed since [Ashley’s] death, and I have studied medical ethics and end-of-life issues, it has become clearer to me that there is a gap in the scope of medical care for terminally ill persons.” From “At Face Value.”
According to the US government’s plan for federal involvement in an influenza pandemic, much of the burden will fall on state and local governments and health care workers.
Recent emphases on quality measurement and information technology (IT) are associated with both expected and unexpected consequences.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
For your patients: Information about randomized controlled trials.
This Week in JAMA . JAMA. 2006;295(23):2693. doi:10.1001/jama.295.23.2693