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In This Issue of JAMA
May 12, 2015


JAMA. 2015;313(18):1773-1775. doi:10.1001/jama.2014.11735
Professionalism, Governance

Edited by Howard Bauchner, MD, and Phil B. Fontanarosa, MD, MBA

Professionalism, Governance, and Self-regulation of Medicine

US health care is in the midst of substantial change, potentially challenging the well-established self-governing structure of the medical profession and the professionalism of physicians. This issue of JAMA is a theme issue on professionalism and self-governance in medicine across the spectrum of physician education and clinical practice and with particular attention to maintenance of certification, which has become highly contentious. Nineteen Viewpoints and 3 Editorials by leading scholars and academic leaders consider the roles and responsibilities of governing and accrediting bodies and of professional organizations and societies for ensuring effective governance and professionalism in medicine. Major themes include whether physician competency and professionalism are ensured through existing licensing, certification, and accreditation processes or whether changes are needed to maintain the public’s trust in professional self-regulation. Another theme is the importance of patients’ well-being in physician professionalism and the role of medical education in fostering this quality in trainees and practicing physicians. Viewpoints addressing medical regulation and professionalism in Canada and the United Kingdom and from disciplines other than medicine provide additional perspectives.

Clinical Review & Education

Achalasia—associated with functional loss of nerve cells in the distal esophagus and lower esophageal sphincter and characterized by dysphagia, reflux, and chest pain in the absence of esophageal inflammation or mechanical obstruction—can be difficult to diagnose and treat. Based on a review of 92 articles—including 9 randomized clinical trials evaluating endoscopic and surgical treatment options—Pondolfino and Gawron discuss the epidemiology, pathophysiology, diagnosis, and treatment of achalasia. The authors highlight 3 distinct subtypes of achalasia that have prognostic and therapeutic implications.

Author Audio Interview and Continuing Medical Education

Hoarseness, which may be caused by viral laryngitis, allergy, rhinosinusitis, or laryngopharyngeal reflux, is a commonly reported among patients seeking primary care. An article in JAMA Otolaryngology reported results of a survey, which found many primary care physicians empirically treat chronic hoarseness of unknown origin with reflux medication even when symptoms of gastroesophageal reflux disease are not present. In this From The JAMA Network article, Fisichella discusses appropriate treatment of patients who present with hoarseness.

Hepatitis C virus (HCV) infection affects an estimated 180 million people worldwide. However, detection of HCV infection is difficult because many newly infected individuals have no or mild nonspecific symptoms and a substantial number of persons with chronic HCV infection are unaware they are infected. This JAMA Clinical Guidelines Synopsis by Wray and Davis summarizes the US Preventive Services Task Force Recommendation Statement: Screening for Hepatitis C Virus Infection in Adults, which was based on a review of 182 studies. Screening is recommended for all persons at high risk of HCV infection—particularly those with past or current intravenous drug use. All adults born between 1945 and 1965 may be offered one-time HCV screening.

From The Medical Letter: A 4-Drug Combination for Hepatitis C

This Medical Letter on Drugs and Therapeutics article provides information on a recently approved 4-drug interferon-free, fixed-dose, oral combination treatment for chronic hepatitis C virus (HCV) genotype 1 infection. The combination includes 2 new direct-acting antiviral agents with a pharmacologic enhancer in 1 tablet and a third new direct-acting antiviral agent in a second tablet. Common adverse effects, drug interactions, and dosage and administration information are summarized.