JAMA Forum: What is the Economic Rationale for the Health Care Law’s Individual Mandate?

Austin Frakt, PhD

Austin Frakt, PhD

Tomorrow, the Supreme Court will hear oral arguments on the constitutionality of the individual purchase mandate, which requires most individuals to pay an annual tax penalty if they do not have health insurance by 2014. While some have portrayed the mandate as a novel and dangerous encroachment on freedom, it’s important to realize that it has a reasonably long and well-thought-out rationale supporting it. Continue reading

Sleep Duration—Too Long or Too Short—Appears Linked With Cardiovascular Problems

Sleeping less than 6 hours or more than 8 hours may increase the risk for various cardiovascular complications. (Image: Nicole S. Young/iStockphoto.com)

Chicago—Getting the proper amount of sleep appears protective against experiencing heart problems or stroke.

At today’s scientific session of the American College of Cardiology here in Chicago, researchers presented findings suggesting that those sleeping less than 6 hours of sleep per night are twice as likely as those sleeping 6 to 8 hours per night to experience a stroke or heart attack and 60% more likely to have congestive heart failure. At the other end of the spectrum, those who sleep more than 8 hours per night are twice as likely as those who sleep 6 to 8 hours each night to have angina and they also have a 10% higher chance of having coronary artery disease. Continue reading

JAMA Forum: The Supreme Court and the Health Care Law — Constitutional Ripples Will Affect the Election and Beyond

Lawrence Gostin, JD

Lawrence Gostin, JD

Florida v HHS, a suit brought on behalf of 26 states challenging the constitutionality of the Affordable Care Act (ACA), is a crucial event—crucial because upholding the ACA is critical to the US Constitution and to a humane social policy, bringing America into the fold of civilized nations that guarantee affordable health care for all their people. Continue reading

JAMA Forum: The Stark Choices Ahead on the Future of Health Care

Larry Levitt, MPP

Larry Levitt, MPP

The economy might trump health care in the minds of most Americans as they enter voting booths this November, but there are far-reaching implications for the future of the health system that turn on who wins control of the Presidency, Congress, and state houses across the country. In fact, policy decisions made over the next few years may be among the most consequential for health policy than in any other period since the creation of Medicare and Medicaid in 1965. Continue reading

Debate Continues Over Aspirin Use to Reduce Cancer Risk

New studies suggest that daily aspirin use may reduce the risk of developing or dying of certain cancers, but the evidence is not yet conclusive. (Image: Diane Diederich/iStockphoto.com)

Does daily aspirin reduce the risk of developing or dying of certain cancers? Although some new studies add to the evidence base that aspirin may have such benefits, some caution that more data are needed to weigh risks of treatment and determine which patients might benefit.

A pooled analysis of individual patient data, published online in the Lancet in 2010, suggested that daily aspirin reduced death due to cancer among 25 570 patients enrolled in 8 analyzed trials by 21% (327 deaths among 14 035 taking aspirin vs 347 deaths among 11 535 control participants). In February of this year, the Archives of Internal Medicine published a meta-analysis of 9 trials involving more than 100 000 participants suggesting that aspirin did not reduce cancer mortality. But yesterday, 2 studies published in the Lancet and another in Lancet Oncology suggest, once again, that daily aspirin use reduces cancer mortality. Continue reading

Author Insights: ICU Patients May Benefit From Alternative Sedative

Jukka Takala, MD, PhD, director of the department of intensive care medicine at Bern University Hospital in Switzerland, and his colleagues found evidence that using dexmedetomidine as a sedative for patients in the intensive care unit may offer advantages. Image: Inselspital, Bern University Hospital

Sedation is often required for patients in the intensive care unit (ICU) who are breathing with the assistance of a mechanical ventilator. But patients who are sedated for long periods can experience serious adverse effects, including delirium, posttraumatic stress disorder, or coma. To minimize such effects, many ICU clinicians have begun providing patients with daily breaks from sedation and exploring other strategies to reduce risks to patients, including identifying the safest sedatives.

A pair of clinical trials involving nearly 1000 ICU patients, published today in JAMA by a team of European researchers, suggests that the sedative dexmedetomidine may offer some advantages over 2 sedatives used more frequently in ICUs in the United States, propofol and midazolam. Both multicenter trials found that dexmedetomidine was not inferior to the 2 more commonly used sedatives. The trials were sponsored by Orion Pharma, Espoo, Finland.

One trial, MIDEX, found that patients treated with dexmedetomidine spent less time on mechanical ventilation and had their breathing tubes removed faster than patients taking midazolam. The other trial, PRODEX, found that dexmedetomidine-treated patients had their breathing tubes removed more quickly than did patients treated with propofol, but the difference in the total time spent on ventilation was not significant. Continue reading

Trial Will Probe if New Drug Combination Will Be Effective, Faster TB Treatment

Researchers will be testing a combination drug therapy that they hope will more effectively treat tuberculosis infection. (Image: Janice Carr, Centers for Disease Control and Prevention)

Researchers have launched a trial for a new drug combination that they hope will effectively treat tuberculosis (TB) in less time than is required by current treatment regimens.

Tuberculosis remains one of the world’s leading killers, infecting about 9 million new people each year and claiming about 1.4 million lives annually. Better TB treatment is greatly needed, said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, at today’s briefing. “Although considerable advances in the control of TB have occurred, it’s a disease out of control in many parts of the world,” Fauci said in an interview. “We haven’t had a brand new drug for TB in over 40 years.” Continue reading