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In This Issue of Archives of Internal Medicine
April 26, 2010

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2010;170(8):666. doi:10.1001/archinternmed.2010.87
The Impact of Disclosing Financial Ties in Research and Clinical Care

Financial ties to industry are commonplace, and disclosure of these relationships through public reporting has gained support as a primary management strategy. In this issue, Licurse et al review data from 20 cross-sectional studies assessing the impact of disclosing financial ties on the recipients (patients, research participants, and physicians evaluating research evidence). They find that patients believe that financial ties influence professional behavior and should be disclosed. Patients, physicians, and research participants believe that financial ties decrease the quality of research evidence. For some individuals, knowledge of financial ties would decrease their willingness to participate in research. These conclusions have implications for the optimal design of public reporting systems and highlight the need for future work exploring patient decision making and disclosure of financial ties.

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Exposure to Children as a Risk Factor for Bacteremic Pneumococcal Disease

The population rate of bacteremic pneumococcal disease in adults initially declined after introduction of the pediatric conjugate vaccine in 2000, particularly for serotypes covered by the vaccine. However, the rate of disease due to nonvaccine serotypes is increasing, particularly among older adults. Several risk factors for adult disease in the prevaccine era, including advanced age, smoking, diabetes mellitus, and African American race, currently remain important risk factors. Interestingly, the presence of young children in the home is now associated with a decreased risk of disease among adults.

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Risk of Rehospitalization for Patients Using Clopidogrel With a Proton Pump Inhibitor

Recent pharmacodynamic and retrospective clinical analyses have suggested that proton pump inhibitors (PPIs) may modify the antiplatelet effects of clopidogrel. With claims data from a multistate health insurance plan, a retrospective cohort study of postmyocardial infarction (MI) or coronary stent placement patients was conducted to evaluate rehospitalizations with the use of clopidogrel plus PPI vs clopidogrel alone. Patients receiving clopidogrel plus PPIs had a 93% higher risk of rehospitalization for MI (adjusted hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.05-3.54; [P = .03]) and a 64% higher risk of rehospitalization for MI or coronary stent placement than patients receiving clopidogrel alone (adjusted HR, 1.64; 95% CI, 1.16-2.32 [P = .005]). A subanalysis of patients receiving pantoprazole, the most used PPI, also found that the use of clopidogrel plus pantoprazole had an increased risk of rehospitalization for MI or coronary stent placement compared with the use of clopidogrel alone (adjusted HR, 1.91; 95% CI, 1.19-3.06 [P = .008]).

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Barriers to Routine Risk-Score Use for Healthy Primary Care Patients

Risk scores for the primary prevention of chronic diseases in healthy adults are frequently recommended. In this study, the use and possible barriers toward the use of risk scores for different chronic diseases were investigated among German general practitioners. Forty-two participating general practitioners rarely used risk scores and perceived their routine use as not feasible owing to the political and structural frame in which they work and the intimate nature of the physician-patient relationship. In addition, some uncertainties regarding the definition and use of risk scores indicated that training of physicians could provide some help to overcome underuse. However, findings also highlight that a restructuring of risk scores seems warranted before they can successfully be transferred into routine clinical practice. Ideally, computerized approaches based on medical record data would enable the risk prediction for different chronic diseases at the same time and provide improved visual presentation of risk estimates.

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Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women

This prospective study examined the individual and combined influences of 4 poor health behaviors (smoking, low fruit and vegetable intake, high alcohol consumption, and a low level of physical activity) on total and cause-specific mortality. A representative sample of 4886 men and women 18 years and older from across the United Kingdom was followed up for 20 years (1985-2005). A simple health behavior score was developed, allocating 1 point for each poor behavior. During the follow-up period, 1080 participants died, 431 from cardiovascular diseases, 318 from cancer, and 331 from other causes. Adjusted hazard ratios for total mortality associated with 1, 2, 3, and 4 poor health behaviors compared with none were 1.85, 2.23, 2.76, and 3.49, respectively (P for trend, <.001). The combined effect of poor health behaviors on mortality was substantial, indicating that modest but sustained improvements to diet and lifestyle could have public health benefits.

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