Measuring vs Estimating LDL-C Levels in a Clinical Trial of Bempedoic Acid —Reply
In Reply Drs Xu and Pan comment that the Friedewald formula used for calculating LDL-C levels is not as accurate as direct LDL-C measurement and that our study should have used the latter methodology. Although it is true that methodology improves over time and that there are new methods under exploration that may be more sensitive, those methods have not yet been widely adopted in clinical practice or investigational research. The methods used in our study were consistent with the current gold standard and with the way clinical trial data are typically reported. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Bisphosphonates for Osteopenia in Postmenopausal Women —Reply
In Reply The topic addressed by our article was the efficacy and safety of bisphosphonate treatment for women with postmenopausal osteoporosis, not osteopenia. Dr Snyder comments that we stated that no clinical trials have assessed the benefit of treatment with bisphosphonates in women with osteopenia. However, our article instead stated that while some organizations recommend treatment initiation in postmenopausal women with osteopenia who have a 10-year fracture probability (calculated using the FRAX tool) at or above intervention thresholds proposed by the National Osteoporosis Foundation, the benefit of treatment in pa...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Treatment of Older Adults With Subclinical Hypothyroidism —Reply
In Reply The population distribution of thyrotropin across the human life span has been reported in multiple studies with ambiguous results: both increase and decrease with increasing age have been reported. These inconsistencies may reflect differences in iodine intake across cohorts or age categories and underscore that population distributions alone are unfit to determine reference ranges. Other observational studies of subclinical hypothyroidism, including the NHANES study mentioned by Dr Hershman as well as an individual patient data meta-analysis by Rodondi et al, showed no association of subclinical hypothyroidism w...
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty
This cohort study uses Ontario administrative data to estimate the risk of complications associated with posterior or lateral vs anterior surgical approaches to total hip replacement arthroplasty. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Association Between Uncemented vs Cemented Hemiarthroplasty and Revision Surgery in Hip Fracture
This cohort study compares the rate of aseptic revision among patients with hip fracture undergoing cemented vs uncemented hemiarthroplasty in a large US integrated health care system. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

The Pritikin Diet
This JAMA Patient Page describes the Pritikin diet and its potential benefits and risks. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Rupture
They let me cut the umbilical cord that late night when you convulsed (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

How Becoming a Doctor Made Me a Worse Listener
In this narrative medicine essay, a former National Public Radio reporter turned neurologist regrets time and attention she once had to show interest in and learn about people and tells how she ’s adapted to retain a small measure of that reporter’s curiosity in her interactions with patients. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Hong Kong Unrest Contributes to Increased Mental Health Care Burden
An observational study has linked the social unrest roiling Hong Kong since June 2019 with a 5-fold increase in probable depression and a 6-fold increase in posttraumatic stress disorder (PTSD) symptoms. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

International Measles Vaccination Campaign to Reach Millions
Up to 45 million children in 7 low-income countries will be vaccinated against measles through a campaign launched in February by Gavi, the Vaccine Alliance. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Guided Self-help Program May Help Refugees in Distress
A guided self-help program that uses audio courses and an illustrated book helped reduce psychological distress and improve functioning among female South Sudanese refugees in Uganda, according to the results of a cluster randomized trial. (Source: JAMA)
Source: JAMA - March 17, 2020 Category: General Medicine Source Type: research

Oral Injections Tested in Proof-of-Concept Trial
A microneedle-containing pill safely injected an oral version of a biologic drug directly into the intestinal wall in a first-in-human phase 1 trial, Rani Therapeutics recently announced. The drug, octreotide, is a subcutaneous injection used to treat acromegaly and neuroendocrine disorders. The San Jose –based startup is also developing orally administered injections for diabetes, rheumatoid arthritis, and cardiovascular disease biologics, among others. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

CAR Natural Killer-Cell Therapy Safe and Effective in First Trial
A variation on chimeric antigen receptor (CAR) T-cell therapy that instead modifies natural killer (NK) immune cells appeared to be safe and effective in an ongoing phase 1 and 2 trial of patients with CD19-positive blood cancers. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

23andMe Develops First Drug Compound Using Consumer Data
Direct-to-consumer genetic testing company 23andMe has developed an antibody aimed at treating inflammatory skin conditions. The DNA testing and research outfit licensed the compound to Barcelona-based pharmaceutical firm Almirall in January, its first such deal for a drug compound developed in-house using consumer data. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Data Errors in Table 3 and Figure 1
This article was corrected online. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Measles as Metaphor —What Resurgence Means for the Future of Immunization
With the call for a vaccine to prevent the spread of the newly identified coronavirus (COVID-19), we should not lose sight of a virus we know, for which there has been a vaccine in use for more than 50 years: measles. Measles, one of the most contagious infectious diseases, is the canary in the immunization coal mine. Previously a near rite of passage, annually infecting 3 million to 4 million US children and causing 400 to 500 deaths, measles steadily declined after the 1968 introduction of a safe, highly effective vaccine to the point of declared national elimination (in 2000). (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Alcohol and School Physiologies
In a number of states, at the instance of active temperance workers, laws have been passed prescribing instruction in the public schools as to the toxic action of alcohol. It is charged by some, and very recently by Professor Atwater, whose experiments —previously noted in The Journal—are known throughout the world, that the text-books used contain errors, notably in denying absolutely any food value to alcohol, with other inaccurate statements. He is reported as saying: “There are many errors in these text-books, sometimes the error consist s in stating doubtful theories as attested facts; in other cases...
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Prevalence of Pathogenic Variants in Cancer Susceptibility Genes Among Women With Postmenopausal Breast Cancer
This study uses Women ’s Health Initiative data to compare the prevalence of pathogenic variants (PVs) in breast cancer susceptibility genes in postmenopausal women with vs without breast cancer to guide decisions about who should undergo PV testing. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Prophylaxis, Invasive Fungal Disease, and Neutropenic Children and Young Adults
To the Editor Dr Fisher and colleagues examined prevention of invasive fungal infections in neutropenic patients aged 3 months to 30 years with acute myeloid leukemia with caspofungin vs fluconazole. Caspofungin resulted in a statistically significant lower incidence of invasive fungal disease. However, prophylaxis depends on appropriateness and adequacy of the antifungal medication. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Radiation Oncology Alternative Payment Model
To the Editor Drs Howard and Torres provided a synopsis of the alternative payment model for radiation oncology proposed by the Centers for Medicare& Medicaid Services (CMS). Four points deserve further consideration. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Dissenting Opinions in Nutrition Research
To the Editor In a Viewpoint on the public focus on minor lifestyle issues, Dr Ioannidis illustrated his claim that “[a]dvocacy may even lead to bullying of dissenters” by mentioning an occasion in which “collection of signatures in a petition was orchestrated to request retraction of a dissenter’s article.” (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Prophylaxis, Invasive Fungal Disease, and Neutropenic Children and Young Adults
In Reply We agree with Drs de Lange and Br üggemann that results of a randomized clinical trial comparing prophylaxis therapies need to be interpreted in the context of the target population and the chosen comparator agents. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Radiation Oncology Alternative Payment Model —Reply
In Reply We agree with Dr Royce and colleagues that mandatory participation in the Radiation Oncology Model will add an additional layer of administrative burden and cost that could be disruptive to clinicians in the assigned regions. But voluntary enrollment is also problematic. Low and selective enrollment in voluntary alternative payment models has made them difficult to evaluate. The enrollment target for the Radiation Oncology Model (40% of episodes) is based on statistical power calculations. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Dissenting Opinions in Nutrition Research —Reply
In Reply Ms Liebman comments on a statement in my Viewpoint but provides an incomplete presentation of the lengthy reevaluation process of the article by Teicholz published in the BMJ. The outcome was summarized by Fiona Godlee, the BMJ ’s editor in chief, as follows: “We stand by Teicholz’s article and its critique of this highly influential advisory committee’s processes for reviewing the evidence, and we echo her conclusion” and “The current state of nutrition research should be a matter of grave concern to those att empting to develop evidence based health and economic policies that ...
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Mortality and Hospitalizations for Dually and Nondually Enrolled Medicare Beneficiaries, 2004-2017
This population epidemiology study compares annual changes in all-cause mortality, hospitalization rates, and hospitalization-related mortality among beneficiaries aged 65 years or older dually enrolled in Medicare fee-for-service and Medicaid vs those nondually enrolled (Medicare only). (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Prognosis
All day, the pinstripes of rain beat against the window glass, the frayed leaves soaked through on the bough. Below I can see the dents of the earth filling with pools of water, (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Trauma Surgery for Psychic Damage
In this narrative medicine essay a psychiatrist finds parallels between his attempts to locate the source of a patient ’s psychological trauma and those of trauma surgeons opening up patients to reveal their injuries and shares how a successful connection heals both doctor and patient. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Jama
(Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

Rising Emergency Department Visits for Suicidal Ideation and Self-harm
Emergency departments have seen a 25.5% increase the past 2 years in patients who ’ve had suicidal thoughts, harmed themselves, or both, according to a CDC report. It’s the latest article to raise alarm about rising suicide rates, which have increased by 40% in US working-aged adults in less than 2 decades, according to the agency. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

US Zika-Related Birth Defects in High-Transmission Areas
In US regions with widespread Zika virus transmission, birth defects that possibly were virus-related increased about 4-fold, from 1.3 per 1000 live births between January and March 2016 to 5.6 per 1000 live births in January to March 2017, according to a CDC report. (Source: JAMA)
Source: JAMA - March 10, 2020 Category: General Medicine Source Type: research

New Insight on Preventing EGFR Inhibitor –Induced Adverse Effects
Targeted drugs that bind to and inhibit the epidermal growth factor receptor (EGFR) profoundly benefit many patients with solid tumors without the severe adverse effects associated with chemotherapy and radiation. But the agents can cause stigmatizing facial rashes and other cutaneous symptoms that may decrease cancer treatment adherence and effectiveness. Now, new research published in Science Translational Medicine reveals the mechanisms behind these adverse effects and points to an add-on treatment that might help to prevent them. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Incorrect Wording
This article was corrected online. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Affording Medicines for Today ’s Patients and Sustaining Innovation for Tomorrow
This is a time of unprecedented medical progress. Breakthrough science is transforming patient outcomes and enabling clinicians to treat —and sometimes cure—diseases that previously posed insurmountable challenges to people’s health. However, many individuals in the United States are increasingly concerned about the out-of-pocket expenses they face in gaining access to the care they need. Escalating insurance premiums, co-insur ance expenses, and co-payments can be financially devastating for individuals and families. Many patients with private insurance are shocked to learn that, even when they received ...
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Are Pharmaceutical Companies Earning Too Much?
Some of the most valuable innovations known to medicine have come from the pharmaceutical industry. Yet, the cost of those innovations places new drugs out of reach for many patients and significantly burdens others. Are pharmaceutical companies earning too much? Deciding whether pharmaceutical companies earn too much money is complicated. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Relentless Prescription Drug Price Increases
One in 4 people in the US has difficulty paying the cost of their prescription medications. This stark fact was recently reported in a 2019 Kaiser Family Foundation public opinion poll among a nationally representative random sample of 1205 adults. Persons who reported having the greatest difficulty affording their prescription drugs were those who most needed them, including those who took 4 or more prescription drugs, spent $100 or more per month on their drugs, and reported being in fair or poor health. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

New Nonsurgical Option Approved for Thyroid Eye Disease
The FDA has approved the country ’s first treatment for patients with thyroid eye disease, a rare condition in which inflamed muscles and fatty tissue behind the eyes result in proptosis. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

FDA Policies Address Development of Gene Therapies
As it considers the merits of more than 900 investigational new drug applications for gene therapy products, the FDA released new policies to guide the clinical development and manufacturing of such treatments. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Drug Approved to Aid Youths With Peanut Allergy
A newly approved drug is intended to lessen allergic reactions, including anaphylaxis, in children and adolescents who are allergic to peanuts. An FDA advisory committee supported approval of the treatment, Peanut (Arachis hypogaea) Allergen Powder-dnfp, during a September 2019 meeting. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Audio Highlights
Listen to the JAMA Editor ’s Audio Summary for an overview and discussion of the important articles appearing in this week’s issue of JAMA. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Rising Prices and Health Care “Empires”
The rate of growth of health care expenditures in the United States in 2018 vs 2017 was actually below the annual rate of growth of the US economy as a whole, according to the Centers for Medicare& Medicaid Services (CMS) Office of the Actuary. However, this is more of a reflection of the high annual rate of growth in the US economy in 2018 than a slowing in health care expenditures, which grew at an annual rate of growth of 4.6%. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Toxics
A poison is a substance, which when taken into the system is either absorbed or by its thermal action on the parts with which it is in contact produces deleterious effects. It may seem strange that almost all toxics are innocent, until they reach the circulation of the blood. Their slow or rapid absorption largely determines their deleterious effects upon the system. In our observations we are reminded from time to time of the idiosyncrasies of individuals and we seldom inquire into the causes of these peculiar conditions. It is generally attributed to a perversion of the nervous system, but in truth is caused by a rapid a...
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Sponsorship and Funding for Gene Therapy Trials in the United States
This study characterizes government, academia, and private funding for gene therapy trials in the United States by technology type and therapeutic and disease area. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Strategies to Avoid Extubation Failure Among ICU Patients
To the Editor Dr Thille and colleagues reported that the combination of noninvasive ventilation (NIV) and high-flow nasal oxygen decreased the reintubation rate in patients at high risk of extubation failure compared with high-flow nasal oxygen alone. Before postextubation practice is changed, and given the burden on staff and costs of NIV, the settings in which this strategy is beneficial should be considered. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Informed Consent for Stem Cell –Based Interventions
To the Editor Dr Sugarman and colleagues reported on the professional standards for informed consent for patients seeking stem cell interventions outside a clinical trial from the International Society for Stem Cell Research. We agree that informed consent is the cornerstone of ethical clinical practice and that patients need accurate information to make a reasonable choice when considering a stem cell intervention. These standards will aid the efforts of those engaged in responsibly advancing stem cell medicine. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Wasteful Health Care Spending in the United States
To the Editor Dr Shrank and colleagues reported on “the sources of waste in health care spending” in the United States. Although we agree with the authors that an understanding of wasteful spending and overtreatment is important, we are concerned about their use of the term end-of-life care. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Wasteful Health Care Spending in the United States
To the Editor Studying unnecessary spending in the US health care system, Dr Shrank and colleagues updated previous estimates of wasteful spending to between $760 billion and $935 billion per year, or approximately 25% of total US health care expenditures. However, we believe their estimates of wasteful spending are likely underestimated because they did not consider the effect of health behaviors. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Strategies to Avoid Extubation Failure Among ICU Patients —Reply
In Reply Our clinical trial demonstrated that NIV alternating with high-flow nasal oxygen between NIV sessions applied after extubation of at-risk patients in the intensive care unit (ICU) significantly decreased reintubation rates compared with high-flow nasal oxygen alone. We agree with Dr Matsuda that NIV is a burden and that, consequently, this strategy must be well-justified before changing clinical practice. The trial was performed in 30 French ICUs and all centers had NIV experience, with a ratio of 2 nurses for 5 patients, and usually without a respiratory therapist. Although the protocol planned to apply NIV for a...
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research

Wasteful Health Care Spending in the United States —Reply
In Reply As we stated in our article on waste in the US health care system, our review was necessarily broad. We believe our results are conservative and imprecise, limited by existing published data. Our goal was to assess sources of waste broadly, using previously defined categories, and to update perceived areas of opportunity and directions for future improvement. (Source: JAMA)
Source: JAMA - March 3, 2020 Category: General Medicine Source Type: research