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The article reports on a policy paper about the future of funding and care of patients with human immunodeficiency virus (HIV) in the U.S. The paper was developed by the Ryan White Medical Providers Coalition (RWMPC) and the HIV Medicine Association (HIVMA). The paper highlighted concerns about the future of HIV care and funding as health care and economic situations in the country change. The Ryan White HIV/AIDS Program has been providing HIV-related services.

Reports that the U.S. Food and Drug Administration (FDA) has released a draft 'concept paper' on guidelines for pharmaceutical company support of scientific or educational programs. Request for comments of the FDA from medical educators and interested parties; Increase in the promotion of sales of prescription drugs; Provision of balanced information for physicians.

The article states that the U.S. National Library of Medicine has released a selection of papers written by molecular biologist and science administrator Harold Varmus. He was a former cancer researcher, National Institutes of Health Director, and Nobel laureate. Varmus helped develop the theory that cancer is caused by mutations in a person's own genes. The papers can be found at the web site http://www.profiles.nlm.nih.gov. The Library worked with the University of California, San Francisco to digitize Varmus' papers.

A call for papers for the annual theme issue of the "Journal of the American Medical Association" on violence and human rights in 2012 is presented.

Discusses an ban by the United States Department of the Treasury's Office of Foreign Assets Control last year that journals could publish manuscripts from authors living in countries facing United States trade embargoes, but could not edit such papers. Reason why journals cannot edit foreign manuscripts, in regards to economic value of the manuscripts; Amount of fines that could be levied against journals if they were to edit foreign manuscripts; Efforts by Institute of Electrical and Electronic Engineers to get the United State's government to soften its stance; Renewed stance of the government on the editing of foreign manuscripts.

Opinion. Presents a position paper from the Surgical Section of the National Medical Association. Financial aspects of caring for injured victims of violence; Viewing the issue from a public health perspective; Organizations which have addressed the issue of injury prevention.

Importance: Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.Objectives: To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.Evidence Review: Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings.Findings: The US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress.Conclusions and Relevance: The action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the aging of the population and the implications for medical care and health care systems. How the demographic trend will affect health care and society; Specific problems that the U.S. faces which are related to aging; Invitation to authors to submit manuscripts on topics such as disease interventions, dementia, incontinence, diabetes, cancer and others.

This Medical News story examines the outcry over a recently published guideline that found insufficient evidence to recommend eating less red meat. [ABSTRACT FROM AUTHOR]

A list of books submitted to the "Journal of the American Medical Association" is presented, including: "Thieme Atlas of Anatomy: Neck and Internal Organs," by Michael Schuenke, Erik Schulte and Udo Schumacher; "A Personal History of Nuclear Medicine," by Henry N. Wagner Jr.; "The Biology of Cancer," by Robert A. Weinberg; "Crash Course: Immunology," by Robert Novak and James Griffin; "Glaucoma," edited by Franz Grehn and Robert Stamper; "On Call Pediatrics," by James J. Nocton; and many others.

Key Points: Question: Is treatment with a coronary paclitaxel-coated balloon superior to an uncoated balloon for 1-year target lesion failure in patients undergoing percutaneous coronary intervention for in-stent restenosis? Findings: In a multicenter randomized trial of 600 patients designed to support US regulatory approval, target lesion failure was significantly lower in the paclitaxel-coated balloon group (17.9%) compared with the uncoated balloon group (28.6%) (P =.003). Ischemia-driven target lesion revascularization and target vessel myocardial infarction were also lower after treatment with a paclitaxel-coated balloon. Meaning: Treatment with a paclitaxel-coated balloon offers an effective treatment strategy for the management of coronary in-stent restenosis. Importance: Drug-coated balloons offer a potentially beneficial treatment strategy for the management of coronary in-stent restenosis. However, none have been previously evaluated or approved for use in coronary circulation in the United States. Objective: To evaluate whether a paclitaxel-coated balloon is superior to an uncoated balloon in patients with in-stent restenosis undergoing percutaneous coronary intervention. Design, Setting, and Participants: AGENT IDE, a multicenter randomized clinical trial, enrolled 600 patients with in-stent restenosis (lesion length <26 mm and reference vessel diameter >2.0 mm to ≤4.0 mm) at 40 centers across the United States between May 2021 and August 2022. One-year clinical follow-up was completed on October 2, 2023. Interventions: Participants were randomized in a 2:1 allocation to undergo treatment with a paclitaxel-coated (n = 406) or an uncoated (n = 194) balloon. Main Outcomes and Measures: The primary end point of 1-year target lesion failure—defined as the composite of ischemia-driven target lesion revascularization, target vessel–related myocardial infarction, or cardiac death—was tested for superiority. Results: Among 600 randomized patients (mean age, 68 years; 157 females [26.2%]; 42 Black [7%], 35 Hispanic [6%] individuals), 574 (95.7%) completed 1-year follow-up. The primary end point at 1 year occurred in 17.9% in the paclitaxel-coated balloon group vs 28.6% in the uncoated balloon group, meeting the criteria for superiority (hazard ratio [HR], 0.59 [95% CI, 0.42-0.84]; 2-sided P =.003). Target lesion revascularization (13.0% vs 24.7%; HR, 0.50 [95% CI, 0.34-0.74]; P =.001) and target vessel–related myocardial infarction (5.8% vs 11.1%; HR, 0.51 [95% CI, 0.28-0.92]; P =.02) occurred less frequently among patients treated with paclitaxel-coated balloon. The rate of cardiac death was 2.9% vs 1.6% (HR, 1.75 [95% CI, 0.49-6.28]; P =.38) in the coated vs uncoated balloon groups, respectively. Conclusions and Relevance: Among patients undergoing coronary angioplasty for in-stent restenosis, a paclitaxel-coated balloon was superior to an uncoated balloon with respect to the composite end point of target lesion failure. Paclitaxel-coated balloons are an effective treatment option for patients with coronary in-stent restenosis. Trial Registration: ClinicalTrials.gov Identifier: NCT04647253 This clinical trial compares a paclitaxel-coated balloon vs an uncoated balloon in patients with in-stent restenosis undergoing percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Presents an article previously printed in the June 21, 1902 issue of the 'Journal of the American Medical Association.' 'What of the Future?,' an address delivered before the obstetrics and disease of women session at the 53rd annual meeting of the American Medical Association in Saratoga Springs, New York.

This Medical News article is an interview with Ankit Bharat, MD, a surgeon at Chicago's Northwestern Memorial Hospital who performed the first bilateral lung transplant for COVID-19 in the US. [ABSTRACT FROM AUTHOR]

The article focuses on a study related to online professionalism for physicians. It informs that the American College of Physicians (ACP), a professional organization for internal medicine and the Federation of State Medical Boards of the U.S. (FSMB), a national not-for-profit organization, have suggested that the U.S. physicians should carefully use online social networks and e-mails for professional purpose. According to the study, 92 percent of state medical boards have received reports in which they found that physicians violate rules of medical professionalism. It also mentions that physicians should create separate accounts for their professional use on social media.

Importance: Approximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year, including 1.6 million people in the United States. These ulcers precede 80% of lower extremity amputations among people diagnosed with diabetes and are associated with an increased risk of death. Observations: Neurological, vascular, and biomechanical factors contribute to diabetic foot ulceration. Approximately 50% to 60% of ulcers become infected, and about 20% of moderate to severe infections lead to lower extremity amputations. The 5-year mortality rate for individuals with a diabetic foot ulcer is approximately 30%, exceeding 70% for those with a major amputation. The mortality rate for people with diabetic foot ulcers is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcers. People who are Black, Hispanic, or Native American and people with low socioeconomic status have higher rates of diabetic foot ulcer and subsequent amputation compared with White people. Classifying ulcers based on the degree of tissue loss, ischemia, and infection can help identify risk of limb-threatening disease. Several interventions reduce risk of ulcers compared with usual care, such as pressure-relieving footwear (13.3% vs 25.4%; relative risk, 0.49; 95% CI, 0.28-0.84), foot skin measurements with off-loading when hot spots (ie, greater than 2 °C difference between the affected foot and the unaffected foot) are found (18.7% vs 30.8%; relative risk, 0.51; 95% CI, 0.31-0.84), and treatment of preulcer signs. Surgical debridement, reducing pressure from weight bearing on the ulcer, and treating lower extremity ischemia and foot infection are first-line therapies for diabetic foot ulcers. Randomized clinical trials support treatments to accelerate wound healing and culture-directed oral antibiotics for localized osteomyelitis. Multidisciplinary care, typically consisting of podiatrists, infectious disease specialists, and vascular surgeons, in close collaboration with primary care clinicians, is associated with lower major amputation rates relative to usual care (3.2% vs 4.4%; odds ratio, 0.40; 95% CI, 0.32-0.51). Approximately 30% to 40% of diabetic foot ulcers heal at 12 weeks, and recurrence after healing is estimated to be 42% at 1 year and 65% at 5 years. Conclusions and Relevance: Diabetic foot ulcers affect approximately 18.6 million people worldwide each year and are associated with increased rates of amputation and death. Surgical debridement, reducing pressure from weight bearing, treating lower extremity ischemia and foot infection, and early referral for multidisciplinary care are first-line therapies for diabetic foot ulcers. This Review summarizes current evidence regarding the epidemiology, pathophysiology, diagnosis, treatment, and prevention of diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Context: Notifiable disease surveillance is essential to rapidly identify and respond to outbreaks so that further illness can be prevented. Automating reports from clinical laboratories has been proposed to reduce underreporting and delays.Objective: To compare the timeliness and completeness of a prototypal electronic reporting system with that of conventional laboratory reporting.Design: Laboratory-based reports for 5 conditions received at a state health department between July 1 and December 31, 1998, were reviewed. Completeness of coverage for each reporting system was estimated using capture-recapture methods.Setting: Three statewide private clinical laboratories in Hawaii.Main Outcome Measures: The number and date of reports received, by reporting system, laboratory, and pathogen; completeness of data fields.Results: A total of 357 unique reports of illness were identified; 201 (56%) were received solely through the automated electronic system, 32 (9%) through the conventional system only, and 124 (35%) through both. Thus, electronic reporting resulted in a 2.3-fold (95% confidence interval [CI], 2.0-2.6) increase in reports. Electronic reports arrived an average of 3.8 (95% CI, 2.6-5.0) days earlier than conventional reports. Of 21 data fields common to paper and electronic formats, electronic reports were significantly more likely to be complete for 12 and for 1 field with the conventional system. The estimated completeness of coverage for electronic reporting was 80% (95% CI, 75%-85%) [corrected] compared with 38% (95% CI, 36%-41%) [corrected] for the conventional system.Conclusions: In this evaluation, electronic reporting more than doubled the total number of laboratory-based reports received. On average, the electronic reports were more timely and more complete, suggesting that electronic reporting may ultimately facilitate more rapid and comprehensive institution of disease control measures. [ABSTRACT FROM AUTHOR]

Importance: Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%. Observations: Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P <.001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P =.06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P =.02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation. Conclusions and Relevance: The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide. This review summarizes current evidence regarding diagnosis and treatment of primary malignant brain tumors in adults. [ABSTRACT FROM AUTHOR]

This article reports on tools available for predicting violent behavior in people with severe mental illness. The tools were presented at the annual meeting of the American Psychiatric Association (APA) and range from paper and pencil questionnaires to software programs. Each tool compares an individual's characteristics to known predictors of violence and scores where a person falls on a risk scale. Studies of clinicians' impressions and experience in judging a person prone to violence, without the aid of the available tools, show that the accuracy rate ranged from 14 percent to 53 percent.

The article presents a call for papers to be published in a special October, 2008 issue devoted to the health of the U.S. Preference will be given to papers describing original research that presents new scientific understanding backed by solid data. Any topic related to the nation's health is eligible, including national health status, the composition of the health care work force, econometric analysis of health care reform, and comparative analyses with health care systems in other countries.

A list of books received by the "Journal of the American Medical Association" for review is presented. Titles include "Prostate Cancer: Principles and Practice," "Pain: New Essays on Its Nature and the Methodology of Its Study," "Faces of Osteoporosis and the Stories Behind Them," 'Frantz Fanon: A Portrait" and "AJCC Cancer Staging Atlas." Books on medical topics such as immunology, infectious diseases, otolaryngology, pediatrics, pathology and sports exercise are also listed.

Presents an editorial on graduate medical education research in the 21st century. Comments on a report in this issue on residency burnout; Belief that the methodological weakness of the evidence leaves as many questions as answers; Increase in studies of graduate medical students over the years but need for much more; Questions on who will fund the needed research; Changes in medical education over the years; Recent rulings on work hours and the National Resident Matching Program; Commitment of this magazine to advancing the science of post-graduate medical training; Encouragement for students, residents and others to submit papers on the topic.

Importance: Unintended pregnancy is common in the US and is associated with adverse maternal and infant health outcomes; however, estimates of these associations specific to current US populations are lacking.Objective: To evaluate associations of unintended pregnancy with maternal and infant health outcomes during pregnancy and post partum with studies relevant to current clinical practice and public health in the US.Data Sources: Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, PsycINFO, SocINDEX, and MEDLINE databases (January 1, 2000, to June 15, 2022) and manual review of reference lists.Study Selection: Epidemiologic studies relevant to US populations that compared key maternal and infant health outcomes for unintended vs intended pregnancies and met prespecified eligibility criteria were included after investigators' independent dual review of abstracts and full-text articles.Data Extraction and Synthesis: Investigators abstracted data from publications on study methods, participant characteristics, settings, pregnancy intention, comparators, confounders, and outcomes; data were validated by a second investigator. Risk of bias was independently dual rated by investigators using criteria developed by the US Preventive Services Task Force. Results of studies controlling for confounders were combined by using a profile likelihood random-effects model.Main Outcomes and Measures: Prenatal depression, postpartum depression, maternal experience of interpersonal violence, preterm birth, and infant low birth weight.Results: Thirty-six studies (N = 524 522 participants) were included (14 cohort studies rated good or fair quality; 22 cross-sectional studies); 12 studies used large population-based data sources. Compared with intended pregnancy, unintended pregnancy was significantly associated with higher odds of depression during pregnancy (23.3% vs 13.9%; adjusted odds ratio [aOR], 1.59 [95% CI, 1.35-1.92]; I2 = 85.0%; 15 studies [n = 41 054]) and post partum (15.7% vs 9.6%; aOR, 1.51 [95% CI, 1.40-1.70]; I2 = 7.1%; 10 studies [n = 82 673]), interpersonal violence (14.6% vs 5.5%; aOR, 2.22 [95% CI, 1.41-2.91]; I2 = 64.1%; 5 studies [n = 42 306]), preterm birth (9.4% vs 7.7%; aOR, 1.21 [95% CI, 1.12-1.31]; I2 = 1.7%; 10 studies [n = 94 351]), and infant low birth weight (7.3% vs 5.2%; aOR, 1.09 [95% CI, 1.02-1.21]; I2 = 0.0%; 8 studies [n = 87 547]). Results were similar in sensitivity analyses based on controlling for history of depression for prenatal and postpartum depression and on study design and definition of unintended pregnancy for relevant outcomes. Studies provided limited sociodemographic data and measurement of confounders and outcomes varied.Conclusions and Relevance: In this systematic review and meta-analysis of epidemiologic observational studies relevant to US populations, unintended pregnancy, compared with intended pregnancy, was significantly associated with adverse maternal and infant outcomes.Trial Registration: PROSPERO Identifier: CRD42020192981. [ABSTRACT FROM AUTHOR]

Importance: Prescription drug spending is a topic of increased interest to the public and policymakers. However, prior assessments have been limited by focusing on retail spending (Part D-covered drugs), omitting clinician-administered (Part B-covered) drug spending, or focusing on all fee-for-service Medicare beneficiaries, regardless of their enrollment into prescription drug coverage.Objective: To estimate the proportion of health care spending contributed by prescription drugs and to assess spending for retail and clinician-administered prescriptions.Design, Setting, and Participants: Descriptive, serial, cross-sectional analysis of a 20% random sample of fee-for-service Medicare beneficiaries in the United States from 2008 to 2019 who were continuously enrolled in Parts A (hospital), B (medical), and D (prescription drug) benefits, and not in Medicare Advantage.Exposure: Calendar year.Main Outcomes and Measures: Net spending on retail (Part D-covered) and clinician-administered (Part B-covered) prescription drugs; prescription drug spending (spending on Part B-covered and Part D-covered drugs) as a percentage of total per-capita health care spending. Measures were adjusted for inflation and for postsale rebates (for Part D-covered drugs).Results: There were 3 201 284 beneficiaries enrolled in Parts A, B, and D in 2008 and 4 502 718 in 2019. In 2019, beneficiaries had a mean (SD) age of 71.7 (12.0) years, documented sex was female for 57.7%, and 69.5% had no low-income subsidies. Total per-capita spending was $16 345 in 2008 and $20 117 in 2019. Comparing 2008 with 2019, per-capita Part A spending was $7106 (95% CI, $7084-$7128) vs $7120 (95% CI, $7098-$7141), Part B drug spending was $720 (95% CI, $713-$728) vs $1641 (95% CI, $1629-$1653), Part B nondrug spending was $5113 (95% CI, $5105-$5122) vs $6702 (95% CI, $6692-$6712), and Part D net spending was $3122 (95% CI, $3117-$3127) vs $3477 (95% CI, $3466-$3489). The proportion of total annual spending attributed to prescription drugs increased from 24.0% in 2008 to 27.2% in 2019, net of estimated rebates and discounts.Conclusions and Relevance: In 2019, spending on prescription drugs represented approximately 27% of total spending among fee-for-service Medicare beneficiaries enrolled in Part D, even after accounting for postsale rebates. [ABSTRACT FROM AUTHOR]

The article discusses the health care crisis in the United States and invites those who are serious scholars in the field of medical care to submit manuscripts on topics dealing with health care for a March 2007 special thematic issue of the "Journal of the American Medical Association." The article encourages papers to focus on access to health care as well as the economic ramifications associated with potential solutions. The author writes that the amount of people in the U.S. who are unable to receive adequate medical care is on the rise.

This study uses public data to examine the nature and extent of health data confidentiality breaches from 2010 through 2017 [ABSTRACT FROM AUTHOR]

Importance: Sickle cell disease (SCD) is an inherited disorder of hemoglobin, characterized by formation of long chains of hemoglobin when deoxygenated within capillary beds, resulting in sickle-shaped red blood cells, progressive multiorgan damage, and increased mortality. An estimated 300 000 infants are born annually worldwide with SCD. Most individuals with SCD live in sub-Saharan Africa, India, the Mediterranean, and Middle East; approximately 100 000 individuals with SCD live in the US.Observations: SCD is diagnosed through newborn screening programs, where available, or when patients present with unexplained severe atraumatic pain or normocytic anemia. In SCD, sickling and hemolysis of red blood cells result in vaso-occlusion with associated ischemia. SCD is characterized by repeated episodes of severe acute pain and acute chest syndrome, and by other complications including stroke, chronic pain, nephropathy, retinopathy, avascular necrosis, priapism, and leg ulcers. In the US, nearly all children with SCD survive to adulthood, but average life expectancy remains 20 years less than the general population, with higher mortality as individuals transition from pediatric to adult-focused health care systems. Until 2017, hydroxyurea, which increases fetal hemoglobin and reduces red blood cell sickling, was the only disease-modifying therapy available for SCD and remains first-line therapy for most individuals with SCD. Three additional therapies, L-glutamine, crizanlizumab, and voxelotor, have been approved as adjunctive or second-line agents. In clinical trials, L-glutamine reduced hospitalization rates by 33% and mean length of stay from 11 to 7 days compared with placebo. Crizanlizumab reduced pain crises from 2.98 to 1.63 per year compared with placebo. Voxelotor increased hemoglobin by at least 1 g/dL, significantly more than placebo (51% vs 7%). Hematopoietic stem cell transplant is the only curative therapy, but it is limited by donor availability, with best results seen in children with a matched sibling donor. While SCD is characterized by acute and chronic pain, patients are not more likely to develop addiction to pain medications than the general population.Conclusions and Relevance: In the US, approximately 100 000 people have SCD, which is characterized by hemolytic anemia, acute and chronic pain, acute chest syndrome; increased incidence of stroke, nephropathy, and retinopathy; and a life span that is 20 years shorter than the general population. While hydroxyurea is first-line therapy for SCD, L-glutamine, crizanlizumab, and voxelotor have been approved in the US since 2017 as adjunctive or second-line treatments, and hematopoietic stem cell transplant with a matched sibling donor is now standard care for severe disease. [ABSTRACT FROM AUTHOR]

This section offers news briefs related to medical policy and public health in the U.S. as of October 9, 2013. The Occupational Safety and Heath Administration (OSHA) announced a proposed rule on August 23 to reduce worker exposure to crystalline silica. A Government Accountability Office (GAO) report criticized the performance pay policy of the Department of Veterans Affairs (VA). A series of papers on modernizing Medicare was issued by some House Republicans.

This article reports that gay rights groups are asking the U.S. Senate to reject the nomination of James Holsinger to become the country's Surgeon General because of a paper he wrote 16 years ago that described homosexuality as "biologically unnatural." Holsinger was nominated for the job by U.S. President George W. Bush and at the time of nomination, the President praised Holsinger for his focus on educating parents and children about childhood obesity. Matt Foreman, executive director of the National Gay and Lesbian Task Force, says that the paper authored by Holsinger shows that his bias will not allow him to look objectively at scientific information.

The author reflects on the achievements as well as the possible future of the Affordable Care Act (ACA) legislation. The author referred to the challenges faced by the legislation prior to implementation including that from the Supreme Court as well as the U.S. Congress with the slim majority Senate approval. The author applauded the innovative thrusts of ACA despite the shortcomings on truly making health care more affordable with mention of the accountable care organization (ACO) system.

Presents a paper that appeared in the "Journal of the American Medical Association" on April 23, 1904. Report that the Elsberg bill abolishing the office of coroner in Greater New York has been passed; Power of investigation that remains to the coroners still in office; Assertion that miscarriages of justice have occurred due to the inadequacy of coroners; Way that deaths will be assessed by medical examiners.

Presents a letter to the editor in response to a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

Presents a letter to the editor in response to a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

Presents the author's response to letters to the editor regarding a study of computerized physician order entry systems and medication errors, published in the March 10, 2005 edition of the "Journal of American Medical Association."

This Medical News article is our fifth-annual roundup of the top-viewed articles from each of the JAMA Network Journals. [ABSTRACT FROM AUTHOR]

Clinical preventive service recommendations from the US Preventive Services Task Force (USPSTF) are based on transparent, systematic, and rigorous methods that consider the certainty of the evidence and magnitude of net benefit. These guidelines aim to address the needs of diverse populations. Biological sex and gender identity are sources of diversity that are not often considered in studies of clinical preventive services that inform the recommendations, resulting in challenges when evaluating the evidence and communicating recommendations for persons in specific gender identification categories (man/woman/gender nonbinary/gender nonconforming/transgender). To advance its methods, the USPSTF reviewed its past recommendations that included the use of sex and gender terms, reviewed the approaches of other guideline-making bodies, and pilot tested strategies to address sex and gender diversity. Based on the findings, the USPSTF intends to use an inclusive approach to identify issues related to sex and gender at the start of the guideline development process; assess the applicability, variability, and quality of evidence as a function of sex and gender; ensure clarity in the use of language regarding sex and gender; and identify evidence gaps related to sex and gender. Evidence reviews will identify the limitations of applying findings to diverse groups from underlying studies that used unclear terminology regarding sex and gender. The USPSTF will use gender-neutral language when appropriate to communicate that recommendations are inclusive of people of any gender and will clearly state when recommendations apply to individuals with specific anatomy associated with biological sex (male/female) or to specific categories of gender identity. The USPSTF recognizes limited evidence to inform the preventive care of populations based on gender identity. [ABSTRACT FROM AUTHOR]

Assesses the concerns raised regarding the launching of a federal program to vaccinate a half million U.S. health care workers with the smallpox vaccine. Who will receive the vaccination; Mandatory immunization of 500,000 military personnel; Questions about compensation raised by an expert panel convened by the Institute of Medicine; Lack of compensation provisions for those individuals who are harmed by the vaccine; Expert panel urges more deliberation, analysis and evaluation by the government; Report that a number of hospitals across the country are declining to participate in the program because of concerns such as the vaccine's potential adverse effects, worker's compensation issues, and the possibility of inadvertant exposure of vulnerable individuals to vaccinia shed by vaccinated volunteers.

Presents a study to determine the initial effect of the North Carolina graduated driver licensing system on crashes among 16-year-old drivers. Design; Results; Conclusion that the system produced substantial declines in 16-year-old driver crashes.

The article covers "Health Insurance and the Medical Profession," an article by Dr. Alexander Lambert in the January 27, 1917 issue of "JAMA: Journal of the American Medical Association."

Calls for research papers, critical reviews, and commentaries to be submitted for the 1999 medical education issue of 'JAMA: Journal of the American Medical Association.' The topic as evolving challenges to medical education in the United States due to resource constraints, population diversity and aging, and chronic disease survival; Brief discussion of Kenneth Ludmerer's book, 'Time to Heal.'

Context: The risk of possible transmission of bovine spongiform encephalopathy (BSE) in the United States is a substantial public health concern.Objective: To systematically review the current scientific literature and discuss legislation and regulations that have been implemented to prevent the disease.Methods: Literature review using the MEDLINE, EMBASE, and Lexis/Nexis databases for 1975 through 1997 on the terms bovine spongiform encephalopathy, prion diseases, prions, and Creutzfeldt-Jakob syndrome. The Internet was used to identify regulatory actions and health surveillance.Data Extraction: MEDLINE, EMBASE, and Lexis/Nexis databases were searched from 1975 through 1997 for English-language articles that provided information on assessment of transmission risk.Results: Unique circumstances in the United Kingdom caused the emergence and propagation of BSE in cattle, including widespread use of meat and bonemeal cattle feed derived from scrapie-infected sheep and the adoption of a new type of processing that did not reduce the amount of infectious prions prior to feeding. Many of these circumstances do not exist in the United States. In the United Kingdom, new variant Creutzfeldt-Jakob disease probably resulted from the ingestion of BSE-contaminated processed beef. The United Kingdom and the European Union now have strong regulations in place to stop the spread of BSE. While BSE has not been observed in the United States, the US government has surveillance and response plans in effect.Conclusions: Current risk of transmission of BSE in the United States is minimal because (1) BSE has not been shown to exist in this country; (2) adequate regulations exist to prevent entry of foreign sources of BSE into the United States; (3) adequate regulations exist to prevent undetected cases of BSE from uncontrolled amplification within the US cattle population; and (4) adequate preventive guidelines exist to prevent high-risk bovine materials from contaminating products intended for human consumption. [ABSTRACT FROM AUTHOR]

Objective: To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention.Participants: A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented.Evidence: The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles.Consensus Process: Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine.Conclusion: Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. [ABSTRACT FROM AUTHOR]

Context: The professional integrity of scientists is important to society as a whole and particularly to disciplines such as medicine that depend heavily on scientific advances for their progress.Objective: To characterize the professional norms of active scientists and compare them with those of individuals with institutional responsibility for the conduct of research.Design: A mailed survey consisting of 12 scenarios in 4 domains of research ethics. Respondents were asked whether an act was unethical and, if so, the degree to which they considered it unethical and to select responses and punishments for the act.Participants: A total of 924 National Science Foundation research grantees in 1993 or 1994 in molecular or cellular biology and 140 representatives from the researchers' institutions to the US Department of Health and Human Services Office of Research Integrity.Main Outcome Measures: Percentage of respondents considering an act unethical and the mean malfeasance rating on a scale of 1 to 10.Results: A total of 606 research grantees and 91 institutional representatives responded to the survey (response rate of 69% of those who could be contacted). Respondents reported a hierarchy of unethical research behaviors. The mean malfeasance rating was unrelated to the characteristics of the investigator performing the hypothetical act or to its consequences. Fabrication, falsification, and plagiarism received malfeasance ratings higher than 8.6, and virtually all thought they were unethical. Deliberately misleading statements about a paper or failure to give proper attribution received ratings between 7 and 8. Sloppiness, oversights, conflicts of interest, and failure to share were less serious still, receiving malfeasance ratings between 5 and 6. Institutional representatives proposed more and different interventions and punishments than the scientists.Conclusions: Surveyed scientists and institutional representatives had strong and similar norms of professional behavior, but differed in their approaches to an unethical act. INSET: Scenario. [ABSTRACT FROM AUTHOR]

To investigate disciplinary differences in how scientific journals evaluate submissions, I collected data from the Astrophysical Journal, Physiological Zoology, and the American Sociological Review. Referees' evaluations of submissions to these journals differed strikingly: nearly half of the referee reports for American Sociological Review recommended outright rejection, while the corresponding proportions for the other two journals were about one fourth and one tenth. Final dispositions show even greater variation, with Astrophysical Journal accepting 91% of submissions, Physiological Zoology 59%, and American Sociological Review 13%. The journals also differed substantially in the average number of revisions of eventually accepted papers and the average time lags between submission and final editorial decisions. Such differences conform to claims that disciplinary differences in consensus on research priorities and procedures contribute to variation in typical journal peer review systems. Review systems, in turn, influence authors' experiences in the peer review process. [ABSTRACT FROM AUTHOR]

Reports on the President's Council on Bioethics and its white paper "Alternative Sources of Human Pluripotent Stem Cells," in light of research in South Korea that developed a method for creating embryos with cloning. The U.S. stance on federal funding on stem cell research; Methods the council considered to generate stem cells; The debate over ethical and scientific issues related to embryonic stem cell research; Views of council members, including Janet D. Rowley; The pros and cons of blastomere extraction and other approaches for deriving stem-cell lines.

In the article, the author discusses the need for medical practitioners to determine what is best for their practice rather than follow the trends in medicine as of November 1895. He claims that the trends where physicians and surgeons allow reporters during their operations and daily bulletins of cases should not be the focus of rational or state medicine. He also talks about the importance of preventive medicine in health care.

The article presents abstracts of papers on medical topics, including "Anterior Ethmoidal Artery Septal Flap for the Management of Septal Perforation," "Functional and Oncologic Results of Extended Supracricoid Partial Laryngectomy," and "Deployment and Mental Health Diagnoses Among Children of U.S. Army Personnel."

A letter to the editor is presented about a study on the efficacy of the Medical Scientist Training Programs (MSTP) in the U.S.

The authors propose the development of a national strategy to protect public health data in the U.S. They explain the provisions of federal privacy law that relate to public health data, including the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and the Federal Policy for the Protection of Human Subjects. The authors also recommend ethical guidelines for the collection, storage and utilization of public health data.

The author expresses his opinion about the recommendations by the U.S. Medicare Payment Advisory Commission for Medicare payment reforms. He comments on the initiative which establishes a "Medical Home" as a way for primary care clinicians to receive payment for care coordination and integration, quality improvement, and patient education. He believes that the Medical Home initiative fails to recognize the profile of the highest-risk beneficiaries who drive up Medicare costs.