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Highlights for January 1/8, 2019

Mar, 01/01/2019 - 01:00

A First in Non-Hodgkin Lymphoma Treatment

Mar, 01/01/2019 - 01:00
The first biosimilar to rituximab for patients with non-Hodgkin lymphoma has received FDA approval. Rituximab-abbs is indicated for adults with CD20-positive, B-cell non-Hodgkin lymphoma. It can be used as a single agent or in combination with chemotherapy.

New Acute Myeloid Leukemia Therapy

Mar, 01/01/2019 - 01:00
The FDA has approved 2 new acute myeloid leukemia (AML) treatments: one for older adults who cannot undergo intensive chemotherapy and another for patients with a certain genetic mutation.

Oleic Acid Can Make Heart Claim Without Hard Evidence

Mar, 01/01/2019 - 01:00
Although the evidence isn’t conclusive, some products such as cooking oils that contain high oleic acid levels will be able to claim that they may reduce the risk of coronary heart disease.

A Tribute to Lisa M. Schwartz

Mar, 01/01/2019 - 01:00
On a personal note, one of the joys of my position as Editor in Chief of JAMA and the JAMA Network is to meet and talk with individuals whom I have admired my entire academic career. Such was the case in meeting and discussing this article with Lisa and Steven. They clearly had boundless energy and enthusiasm for the topic. I had followed and known of their remarkable work for decades—a powerful team, a couple of enormous intellectual talent. Sadly, Lisa passed away in November 2018. Steven informed us of her death shortly after the manuscript had been accepted, informing us that one of Lisa’s last academic goals was to finish this manuscript and to know that it would be published. It is our privilege to publish this Special Communication from Drs Schwartz and Woloshin. We offer our condolences to Steven and to Lisa and Steven’s family.

A Truly Special Communication

Mar, 01/01/2019 - 01:00
In this issue of JAMA, Lisa M. Schwartz, MD, MS, and Steven Woloshin, MD, publish a Special Communication on medical marketing in the United States, a topic that affects every physician and patient, and virtually every for-profit entity (and many not-for-profit organizations) involved with the US health care system. This article is a unique contribution and represents a comprehensive, rigorous, and insightful report on the ubiquitous, multifaceted, multitargeted, and well-financed phenomenon of medical marketing.

Medication Co-payment Vouchers, Adherence With Antiplatelet Therapy, and MACE After MI

Mar, 01/01/2019 - 01:00
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (such as clopidogrel) is recommended for 1 year after myocardial infarction (MI) to reduce the risk of major adverse cardiovascular events (MACE), with practice guidelines supporting ticagrelor or prasugrel over clopidogrel because of improved clinical outcomes. However, the benefit of dual antiplatelet therapy in improving clinical outcomes can only occur if patients take their medications. Yet medication adherence is suboptimal after MI, with a report from 2008 indicating that 1 in 4 patients did not fill their initial cardiac medication prescriptions in the first month after MI, which is associated with higher mortality and cardiovascular events. Recent studies estimate that the average proportion of time a patient takes a prescribed P2Y12 inhibitor over 1 year ranges from a high of 76% for clopidogrel to a low of 68% for ticagrelor after stent implantation.

Medical Marketing, Trust, and the Patient-Physician Relationship

Mar, 01/01/2019 - 01:00
Individuals in the United States are adept at holding 2 competing views about health care: on one hand, health care revolves around a sacred compact between patients and clinicians and local institutions; on the other hand, health care is a business that operates on (regulated) market principles. The subject of medical marketing brings into relief the tension between these 2 understandings of the health care sector. Indeed, for many years the American Medical Association and the American Hospital Association forbade their members from advertising on the principle that it would subvert professional integrity and undermine patient and public trust. While marketing of health services by health care practitioners and organizations and by other suppliers (eg, pharmaceutical and device manufacturers and laboratories) to consumers has grown rapidly in the decades since those moratoria were lifted and US Food and Drug Administration rules clarified, medical marketing continues to be dominated by marketing to clinicians rather than from them. In this issue of JAMA, Schwartz and Woloshin paint a vivid picture of this evolution across the spectrum of health care services, including both direct-to-consumer (DTC) advertising and marketing to professionals. What do these trends reveal about the changing nature of health care demand, the role of trusted health care professionals, and the need for policy intervention?

Optimized Arylomycins May Help Address Antibiotic Resistance

Mar, 01/01/2019 - 01:00
Antibiotic resistance is currently one of the biggest public health challenges, with multidrug resistant (MDR) bacteria spreading at alarming rates. A recent World Health Organization report reveals widespread occurrence of antibiotic resistance among 500?000 people with suspected bacterial infections across 22 countries.

Cardiac Cruciverbalism

Mar, 01/01/2019 - 01:00
This Arts and Medicine feature contains a heart-themed crossword puzzle.

A Patient With Elevated ?-Fetoprotein Level and Liver Masses

Mar, 01/01/2019 - 01:00
A 55-year-old man with several weeks of malaise, a 6.8-kg weight loss, a CT scan with multifocal liver masses and elevated alkaline phosphatase, ALT, and AFP levels had a heterogeneously enhancing pancreatic-tail mass on triple-phase CT. What would you do next?

For Nobel Peace Prize Winner Dr Denis Mukwege, His Patients Motivate and Inspire

Mar, 01/01/2019 - 01:00
This Medical News article is an interview with Denis Mukwege, MD, cowinner of the 2018 Nobel Peace Prize.

Black Lung Resurgence Raises New Challenges for Coal Country Physicians

Mar, 01/01/2019 - 01:00
In this Medical News & Perspectives article, experts discuss how physicians deal with increasing black lung disease cases among Appalachian miners, many at younger ages than in the past.

Humanizing Artificial Intelligence

Mar, 01/01/2019 - 01:00
In this Viewpoint, Abraham Verghese and Sonoo Thadaney Israni acknowledge the promise of artificial intelligence (AI) for health care, but argue that developers must work with physicians to ensure that any AI health care system helps clinicians deliver better, more equitable humanistic care, not just more accurate, scientific care.

Questions for Artifical Intelligence in Health Care

Mar, 01/01/2019 - 01:00
This Viewpoint discusses questions that should be addressed to successfully integrate artificial intelligence into clinical care.

Risk-Reducing Mastectomy in BRCA1 and BRCA2 Mutation Carriers—A Complex Discussion

Mar, 01/01/2019 - 01:00
This Viewpoint reviews the benefits and risks of risk-reducing mastectomy in otherwise healthy women with BRCA1 and BRCA2 mutations to inform discussions about the proceeding with or foregoing the procedure, and it calls for continued research to understand how to better individualize risk and prevent disease nonsurgically.

Health as a Way of Doing Business

Mar, 01/01/2019 - 01:00
In this Viewpoint, Howard Koh and colleagues discuss the value the public places on corporations that actively promote community health and environmental responsibility, and innovative business strategies that some corporations have implemented to advance consumer, employee, community, and environmental health.

Effect of Linagliptin vs Placebo on Major Cardiovascular Events in High-Risk Adults With Diabetes

Mar, 01/01/2019 - 01:00
This randomized clinical trial compares the effects of the dipeptidyl peptidase 4 inhibitor linagliptin vs placebo plus usual care on cardiovascular (CV) and renal outcomes in adults with type 2 diabetes and high CV and renal risk.

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