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This Week in JAMA
March 24/31, 2004

This Week in JAMA

JAMA. 2004;291(12):1415. doi:10.1001/jama.291.12.1415
Surgical vs Medical Treatment of Menorrhagia

There have been few systematic evaluations comparing surgical vs medical therapy for menorrhagia. Two articles in this issue of THE JOURNAL address this deficiency. In the first, Kuppermann and colleaguesArticle report health-related quality-of-life outcomes from a randomized trial comparing medical treatment including estrogen, progesterone, and a prostaglandin synthetase inhibitor with surgical treatment in women who did not achieve symptom relief with medroxyprogesterone. At 6-month follow-up, women who had a hysterectomy reported greater symptom improvement and higher ratings of overall health than women who received medical therapy; however, at 24 months, many of the differences between the groups were no longer statistically significant. In the second article, Hurskainen and colleaguesArticle report results of a randomized trial comparing treatment with a levonorgestrel-releasing intrauterine system with hysterectomy in terms of cost and quality of life. At 5-year follow-up, the groups did not differ substantially on quality-of-life measures and women were similarly satisfied with their treatment. Although almost half the women randomized to medical treatment eventually underwent hysterectomy, costs for medical therapy were less. In an editorial, Pitkin and ScottArticle discuss the challenges in studying therapies for menorrhagia and treating women with this condition.

Cognitive Behavior Therapy for Hypochondriasis

Hypochondriasis occurs in an estimated 5% of patients, and psychological and pharmacological treatment trials have not demonstrated benefit. Barsky and Ahern report results of a randomized trial involving 6 sessions of scripted, individual cognitive behavior therapy (CBT) compared with usual medical care. At 6- and 12-month follow-up, patients assigned to CBT had fewer hypochondriacal symptoms, less health-related anxiety, and improved health beliefs and attitudes than patients receiving usual care.

Human Rights Abuses in Iraq

Violations of human rights by Saddam Hussein's regime have been widely reported but not systematically studied. Two articles in this issue of THE JOURNAL from authors affiliated with Physicians for Human Rights provide some insight into these events. Amowitz and colleaguesArticle conducted a survey of adults in 3 major cities in southern Iraq to ascertain the nature and scope of abuse and also assessed perspectives on women's rights. Nearly half of the respondents reported human rights abuses perpetrated against household members, including torture, killings, and disappearances/kidnappings. Women's rights to education, access to health care, and equality in decisions about marriage and childbearing were endorsed, but half of both male and female respondents agreed that a man may beat his wife if she disobeys him. In the second article, Reis and colleaguesArticle report results of a survey of physicians regarding physician participation in human rights abuses. Respondents reported widespread human rights abuses, primarily initiated by paramilitary forces and involving physician participation in amputation of ears, falsification of reports of torture and death, and other abuses. Fear of physical harm to oneself or family members was a common explanation for complicity. In an editorial, PellegrinoArticle discusses the necessity for the world's physicians to uphold medicine's moral center even in the face of tyranny and war.

C. Goldsmith, J. Katz, and S. Zaki/CDC
A Piece of My Mind

"Three streets away, a tattered man in a throwaway overcoat sits shivering in the diner." From "Diner on Commercial Street."

Medical News & Perspectives

Amid concerns about the potential emergence of a deadly strain of avian influenza that spreads easily from person to person, researchers are scrambling to develop a protective vaccine (avian influenza A[H5N1] viruses shown above in gold).

C. Goldsmith, J. Katz, and S. Zaki/CDC
Clinician's corner

Part 1Article of this 2-part article discusses appropriate screening, treatment, and referral for eye disorders seen in an older adult primary care population. Four cases presented in part 2Article highlight important strategies for maximizing visual health in patients with comorbid conditions and age-related eye diseases.

JAMA Patient Page

For your patients: Information about hysterectomy.