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The cost of medications can be a barrier to the prescription of evidence-based therapy by physicians and adherence to treatment by patients. Wang and colleagues randomized 301 hospitals enrolling 11 001 adult patients with acute myocardial infarction and found that providing vouchers to offset medication co-payments for P2Y12 inhibitors improved treatment persistence but did not reduce major adverse cardiovascular events. In an Editorial, Jackevicius and Ko suggest that further research on medication adherence should address patients’ values and preferences and explore shared decision-making approaches to prescribing.
CME and Visual Abstract
In patients who receive percutaneous coronary intervention for coronary thrombosis, microvascular obstruction is associated with an unfavorable cardiac prognosis. McCartney and colleagues for the T-TIME Group randomized 440 patients presenting within 6 hours of acute ST-segment elevation myocardial infarction due to occlusion of a major coronary artery and found that intracoronary alteplase given during primary percutaneous intervention did not reduce microvascular obstruction.
The dipeptidyl peptidase 4 inhibitor linagliptin is effective for glycemic management of type 2 diabetes, but cardiovascular safety has not been established. Rosenstock and colleagues for the CARMELINA Investigators randomized 6991 adults with type 2 diabetes at high risk of cardiovascular and kidney disease and found that adding linagliptin to usual care resulted in a noninferior risk of a composite cardiovascular outcome over a median 2.2 years.
Health care organizations and companies that manufacture drugs or laboratory tests use an array of promotional activities to shape public and clinician perceptions about the benefits and harms of health care. In this Special Communication, Schwartz and Woloshin explain medical marketing strategies and their influence on health care spending. In an Editorial, Ortiz and Rosenthal suggest that trust between patients and physicians can be undermined by deceptive marketing of pharmaceuticals and health services.
Editorial 1 and 2 and Editor’s Note
This JAMA Clinical Challenge by Mikolajczyk and colleagues presents a 55-year-old man with multifocal hepatic masses and an elevated α-fetoprotein level but without evidence of chronic liver disease. What would you do next?
Seborrheic keratoses are benign, usually pigmented skin growths that generally do not require treatment but are often removed for cosmetic reasons or because they have become irritated. This Medical Letter on Drugs and Therapeutics discusses the risks and benefits of hydrogen peroxide 40% topical solution for the treatment of raised seborrheic keratoses.
Highlights. JAMA. 2019;321(1):7–9. doi:10.1001/jama.2018.15135
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