In an analysis of data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry, an international prospective cohort of patients with established atherosclerotic arterial disease or at least 3 risk factors for atherothrombosis, Steg and REACH Registry coinvestigatorsArticle assessed 1-year rates of cardiovascular (CV) death, myocardial infarction, and stroke in outpatients. The investigators found high 1-year rates of CV events. Event rates were 2 to 3 times higher among patients with established disease vs those with risk factors only, and these rates were increased among patients with symptomatic disease in multiple locations. In an editorial, McDermottArticle discusses the increasing burden of chronic cardiovascular disease.
Secondary neoplasms are a concern among long-term survivors of cancer therapy. Hijiya and colleagues investigated the incidence and characteristics of secondary neoplasms in a cohort of patients who were treated for childhood acute lymphoblastic leukemia (ALL) between 1962 and 1998 and had a median follow-up time of 18.7 years. The authors report that the cumulative incidence of secondary neoplasms was 4.17% (SE, 0.46%) at 15 years and increased to 10.85% (SE, 1.27%) at 30 years of follow-up, representing a significantly increased risk compared with that of the general population.
Five states and the District of Columbia have mandated disclosure of pharmaceutical company payments to physicians. Ross and colleaguesArticle investigated the accessibility and quality of these data and the prevalence and magnitude of the payments from 2 states, Minnesota and Vermont. The authors report multiple challenges to data accessibility, including company designation of the data as “trade secrets” and missing data. Payments to physicians often exceeded the $100 maximum recommended by professional organizations. In an editorial, Brennan and MelloArticle discuss how the study findings may further undermine public trust in the pharmaceutical industry and regulatory efforts.
Life expectancy at birth is lower for blacks than whites and in the past several decades, this black-white “gap” increased and then declined for reasons not yet explained. Harper and colleagues analyzed national vital statistics data from 1983 to 2003 to examine the contribution of specific age groups and causes of death to changes in the black-white life expectancy gap. Among the authors' findings were that increased mortality among blacks from human immunodeficiency virus (HIV) and heart disease widened the gap between 1983 and 1993, and declines since 1993 can be attributed to mortality improvements in homicide, HIV, unintentional injuries, and, among women, heart disease.
Selective eligibility criteria are central to the feasibility and internal validity of randomized controlled trials (RCTs) but may compromise the generalizability of the trial results. Van Spall and colleagues conducted a systematic review of RCTs published between 1994 and 2006 and found that common medical conditions, age, concomitant medications, and female sex were frequent exclusion criteria. Exclusions were particularly common in drug intervention trials and often were not justified in the context of the trial.
“Maybe we should talk about putting methods in place to attract those students who enter medicine because they care, not because they can.” From “Endangered Species.”
Spurred by concerns about a potential pandemic arising from H5N1 avian influenza, experts are working to establish effective pandemic preparedness strategies at the national, state, and local levels.
In a systematic review and meta-analysis of clinical trials, Hutton and HassanArticle found that in full-term infants, a 2-minute delay in umbilical cord clamping is associated with improved hematologic status. In an editorial, OhArticle discusses implications of this finding for clinical practice.
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 acute lymphoblastic leukemia.
This Week in JAMA . JAMA. 2007;297(11):1163. doi:10.1001/jama.297.11.1163