Author Insights: Remembering the Lost Art of Prognosis

Physicians should provide realism and not allow unchallenged optimistic perceptions to unrealistically cloud patients’ views of their prognoses. (Image: JAMA, ©AMA)

A new study appearing today in the Archives of Internal Medicine adds to the body of evidence that a patient’s hopeful expectations following diagnosis of a disease or condition is associated with clinically important benefits. But Robert Gramling, MD, DSc, and Ronald Epstein, MD, urge physicians to be cautious about excessive optimism.

In an invited commentary in the same issue of the journal, Gramling, an associate professor of family medicine, and Epstein, a professor of family medicine, both at the University of Rochester Medical Center in New York, say that medical training and practice focuses on the arts of diagnosis and treatment while underplaying the art of prognosis. Continue reading

Addiction’s Hijacking of Brain Circuits Key to Related Behavioral Problems

Changes in brain circuitry caused by addiction contribute to poor decision making and behavioral problems in affected individuals. (Image: JAMA, ©AMA)

After decades of research have helped to explain the neurological changes that underlie the severe behavioral and social problems associated with substance abuse, leaders in the field argue that it is time to put that evidence to use for developing better policies for addressing these conditions in the United States.

In an editorial in the February 24 theme issue of Neuron highlighting this evidence base, National Institute on Drug Abuse Director Nora D. Volkow, MD, and colleagues provide a detailed overview of how chronic drug use hijacks the reward circuitry of the brain, impairing the drug user’s ability to seek the things needed for his or her well-being and to avoid negative consequences (Volkow ND et al. Neuron. 2011;69[4]:599-602). Review articles published alongside the editorial provide more comprehensive information about the mechanisms behind these neural changes and genetic vulnerabilities that may underlie them, as well as evidence-based therapies targeting these changes. Continue reading

Bioengineered Fungus Developed to Fight Malaria

Scientists have created a genetically engineered fungus aimed at blocking the spread of malaria parasites from mosquitoes to humans. (Image: James Gathany/CDC)

Researchers have created a genetically engineered fungus with the goal of blocking transmission of malaria parasites by mosquitoes.

In a study appearing today in Science, researchers from the University of Maryland, Johns Hopkins School of Public Health, and the University of Westminster in London describe how they inserted the genes of specific biological agents into Metarhizium anisopliae, a naturally occurring fungus found throughout the world that causes disease in various insects. The transgenic fungi reduced the number of infectious sporozoites by up to 98% in a rodent malarial model. Sporozoites are the form of the malaria parasite that the mosquito transmits to humans. Continue reading

Foodborne Disease Hides in Plain Sight

Jalapeño peppers were implicated in one of the largest salmonella outbreaks in the United States. (Image: James McQuillan/iStockphoto.com)

One of the largest salmonella outbreaks in the United States illustrates just how easy it is for contaminated food to hide in plain sight.

In today’s New England Journal of Medicine, researchers from the US Centers for Disease Control and Prevention, the Indian Health Service, and public health departments in 9 states describe the circuitous route of a 2008 outbreak of Salmonella enterica serotype Saintpaul. Illness from the outbreak was reported in 43 states, the District of Columbia, and Canada. Continue reading

Keeping Alcohol-Impaired Drivers Off the Road

Public health experts hope increasing the use of ignition interlocks will reduce the number of motor vehicle crashes and deaths. (Image: Tuomas Kujansuu/iStockphoto.com)

A systematic review suggests that the estimated 11 000 annual US deaths from alcohol-related motor vehicle crashes can be reduced by expanding the use of ignition interlocks that prevent people who are impaired by alcohol consumption from driving. The review was prepared by the Task Force on Community Preventive Services, an independent, nonfederal, volunteer body whose members are appointed by the director of the US Centers for Disease Control and Prevention.

Ignition interlocks prevent vehicles from being driven by anyone with a blood alcohol concentration above a specified level, usually 0.02 to 0.04 g/dL (the minimum illegal blood alcohol level is 0.08 g/dL in the United States). These interlocks, which are typically installed in vehicles operated by drivers who were previously convicted of driving while intoxicated (DWI), may be mandated through the courts or offered as an alternative to a suspended license. They are usually removed after 6 to 24 months, a time equivalent to a license suspension. Continue reading

Author Insights: Hearing Loss Common in Middle Age

Hearing loss may be more prevalent among middle-aged adults than is commonly recognized. (Image: Linda More/iStockphoto.com)

Hearing loss may be more prevalent among middle-aged adults than is commonly recognized, according to study results published online in the Archives of Otolaryngology—Head & Neck Surgery today.

The findings are the latest from the Beaver Dam Offspring Study, a cohort study of aging in more than 3000 adults aged 21 to 84 years who are the children of individuals who participated in a population-based study called the Epidemiology of Hearing Loss Study. The researchers found that 14.1% of the participants in the Beaver Dam Offspring Study had hearing impairment, with rates increasing to 42.7% in those aged 65 to 84 years. They also found that males and those with noisy jobs or lower educational levels were more likely to experience hearing loss. Some early indicators of cardiovascular disease were also linked to hearing loss. Continue reading

FDA Warns Against Use of Asthma Drug to Prevent Preterm Labor

The US Food and Drug Administration is warning the public about serious cardiac events in pregnant women given terbutaline sulfate to treat or prevent preterm labor (Image: PubChem/NCBI).

Off-label use of the asthma drug terbutaline to prevent preterm labor or for prolonged treatment of preterm labor is not efficacious and poses a risk of serious heart-related problems and death to the mother, according to a warning from the US Food and Drug Administration (FDA).

The FDA said that the warning is based on the agency’s analysis of reports of adverse events, as well as a lack of evidence in the medical literature indicating that terbutaline is safe and effective when used to prevent preterm labor or when used for more than 48 to 72 hours to treat preterm labor. The FDA has identified at least 16 deaths between 1976 and 2009 that were associated with such use, and 12 cases of serious cardiovascular events, such as abnormal heart rhythms, myocardial infarction, fluid in the lungs, hypertension, or an abnormally fast heartbeat. A 2003 guideline from the American College of Obstetricians and Gynecologists also notes these potential maternal cardiac risks, as well as potential adverse events to the fetus or newborn. Continue reading