JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, March 23, 2004)
JAMA NEW RELEASES
STUDIES COMPARE HYSTERECTOMY VS. OTHER MEDICAL TREATMENTS FOR ABNORMAL UTERINE BLEEDING
HUMAN RIGHTS ABUSES COMMON IN SOUTHERN IRAQ BETWEEN 1991 AND 2003
COGNITIVE BEHAVIOR THERAPY EFFECTIVE FOR TREATING PEOPLE WITH HYPOCHONDRIA
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
PLEASE NOTE: BECAUSE JAMA DOES NOT PUBLISH ON THE 5TH WEDNESDAY OF A MONTH, THERE WILL BE NO JAMA OR NEWS RELEASES FOR MARCH 31.
TV Note: This week's JAMA video news release is on comparing the outcomes of a hysterectomy vs. other medical treatments for abnormal uterine bleeding. The release will be fed Tuesday, March 23, from 9:00 - 9:30 a.m. ET on Telstar 6, Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Telstar 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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EMBARGOED FOR RELEASE: 3 P.M. CT, TUESDAY, March 23, 2004
Media Advisory: To contact Miriam Kuppermann, Ph.D., call Eve Harris at 415-885-7277. To contact Ritva Hurskainen, M.D., Ph.D., email: ritva.hurskainen{at}stakes.fi. To contact editorial authors Roy M. Pitkin, M.D., call 760-564-6373, or to reach James R. Scott, M.D., call Cindy Fazzi at 801-581-7387.
STUDIES COMPARE HYSTERECTOMY VS. OTHER MEDICAL TREATMENTS FOR ABNORMAL UTERINE BLEEDING
CHICAGO—Two studies published in the March 24/31 issue of the Journal of the American Medical Association (JAMA) look at the effect of medical treatment compared with hysterectomy on health-related quality of life for women with abnormal uterine bleeding.
According to background information in one of the articles, the Medicine or Surgery (Ms) randomized trial: "Hysterectomy [removal of the uterus] is the most common major surgical procedure performed in the United States for nonobstetric reasons. In 2000, approximately 633,000 hysterectomies were performed, and U.S. women have an estimated 25 percent risk of having their uterus removed." The authors note that most hysterectomies are elective and performed before menopause for abnormal uterine bleeding and other non-life-threatening reasons.
Miriam Kuppermann, Ph.D., M.P.H., from the University of California, San Francisco and colleagues from the Ms Research Group, studied 63 premenopausal women, aged 30 to 50 years, who had abnormal uterine bleeding for a median (mid-point) of four years despite a variety of medical treatments, including hormone therapy (such as medroxyprogesterone acetate). The women were randomly assigned to undergo hysterectomy (n=31) or expanded medical treatment (n=32). The authors assessed overall mental health as the primary outcome, using the Mental Component Summary (MCS) of the 36-Item Short-Form Health Survey (SF-36). Secondary outcomes included physical health, symptom resolution and satisfaction, body image and sexual functioning. The participants were followed-up for two years.
"At 6 months, women in the hysterectomy group had greater improvement in MCS scores than women in the medicine group (8 vs. 2)," the authors report. "They also had greater improvement in symptom resolution (72 vs. 29), symptom satisfaction (44 vs. 7), interference with sex (41 vs. 22), sexual desire (21 vs. 3), health distress (33 vs. 13), sleep problems (13. vs. 1), overall health (12 vs. 2), and satisfaction with health (31 vs. 14). By the end of the two-year follow-up, 17 (53 percent) of the women in the medicine group had requested and received hysterectomy, and these women reported improvements in quality-of-life outcomes during the two years that were similar to those reported by women randomized to the hysterectomy group. Women who continued in the medical treatment also reported some improvements, with the result that most differences between randomized groups at the end of the study were no longer statistically significant in the intention-to-treat analysis."
"We have shown that hysterectomy results in substantial improvement in health-related quality of life within six months for women who have not responded to medroxyprogesterone. Persisting efforts at medical treatment can also produce benefits for many of these women throughout the ensuing two years although others who prolong medical treatment at this stage will decide within a year to have a hysterectomy," the authors conclude.
(JAMA. 2004;291:1447-1455. Available post-embargo at jama.com)
Editor's Note: This research was funded by a grant from the Agency for Healthcare Research and Quality.
FINNISH STUDY COMPARES INTRAUTERINE HORMONE-DELIVERY SYSTEM VS. HYSTERECTOMY
In a second study in the March 24/31 issue of JAMA, researchers from Finland compare outcomes, quality-of-life issues, and costs of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus hysterectomy in the treatment of menorrhagia (abnormally heavy menstrual bleeding).
"The LNG-IUS is an intrauterine system that releases 20 [micrograms] of levonorgesterel every 24 hours over 5 years. The LNG-IUS was developed during the 1980s and licensed first for contraception in Finland in 1990," the authors provide as background information. They add that in many countries, the LNG-IUS is licensed both for contraception and treatment of menorrhagia. In the U.S., the system is only approved for contraception.
Ritva Hurskainen, M.D., Ph.D., from the Helsinki University Hospital, Finland, and colleagues evaluated the outcomes of 236 women, average age of 43 years, who were referred to 5 university hospitals in Finland for complaints of menorrhagia between October 1, 1994 and October 6, 2002. The participants were randomized to treatment with the LNG-IUS (n=119) or hysterectomy (n=117) and were monitored for five years. The researchers used the 5-Dimensional EuroQol and the RAND 36-Item Short-Form Health Survey to measure health-related quality of life (HRQL), as well as psychosocial well-being (anxiety, depression, and sexual function).
"After 5 years of follow-up, 232 women (99 percent) were analyzed for the primary outcomes," the authors report. "The two groups did not differ substantially in terms of HRQL or psychosocial well-being. Although 50 (42 percent) of the women assigned to the LNG-IUS group eventually underwent hysterectomy, the discounted direct and indirect costs in the LNG-IUS group ($2,817 per participant) remained substantially lower than in the hysterectomy group ($4,660). Satisfaction with treatment was similar in both groups."
"Because menorraghia is often a reason for seeking medical attention, it is important to consider the outcomes and costs of various treatment options to provide the most appropriate care. The LNG-IUS may improve HRQL at relatively low cost, undoubtedly enhances patient choice, and may reduce surgery-related costs," the authors write in conclusion.
(JAMA. 2004;291:1456-1463. Available post-embargo at jama.com)
Editor's Note: This study was supported by grants from the Academy of Finland, STAKES, and the Research Funds of the University Hospitals, Finland. The LNG-IUSs were provided free of charge by Leiras Co. (now Schering Co.), Turku, Finland. Please see JAMA study for authors' financial disclosures.
EDITORIAL: EVALUATING GYNECOLOGICAL SURGICAL PROCEDURES
In an accompanying editorial, Roy M. Pitkin, M.D., from the University of California, Los Angeles, and James R. Scott, M.D., from the University of Utah, Salt Lake City, discuss these two randomized controlled studies. "The clinical trials by Kuppermann et al and Hurskainen et al represent important efforts to place a common surgical procedure on firmer, evidence-based grounds."
"One fairly consistent finding in the two investigations is the proportion of women in the control group who, for whatever reason, had hysterectomies (42 percent in the Finnish trial and 52 percent in the U.S. trial). If this result applies to the general population - and in view of the recruitment [of participants for the studies] problems it may not - then women with unsatisfactory response to such first-line 'medical' therapy for excessive uterine bleeding can be counseled that further conservative therapy carries approximately a 50 percent likelihood of ultimately leading to a hysterectomy. ... Does it mean that surgery will likely be necessary eventually anyway, so perhaps better sooner than later, sparing the woman continued symptoms? Or does it mean that there is a 50 percent chance of avoiding the hysterectomy and these odds are worth taking to avoid a major operation?"
The editorial authors suggest that additional randomized clinical trials with longer follow-up are needed "to determine whether these (or other) more conservative treatments are more efficacious and cost-effective in the long run than hysterectomy."
(JAMA. 2004;291:1503-1504. Available post-embargo at jama.com)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org (please note new email address).
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EMBARGOED FOR RELEASE: 3 P.M. CT, TUESDAY, March 23, 2004
Media Advisory: To contact Lynn L. Amowitz, M.D., M.S.P.H., M.Sc., or Chen Reis, J.D., M.P.H., call John Heffernan at 617-695-0041, ext. 210. To contact editorialist Edmund D. Pellegrino, M.D., call Richard Sheehe at 202-994-3631.
HUMAN RIGHTS ABUSES COMMON IN SOUTHERN IRAQ BETWEEN 1991 AND 2003
CHICAGO—Nearly half of the households surveyed in southern Iraq report that human rights abuses occurred among household members between 1991 and 2003, according to a study in the March 24/31 issue of the Journal of the American Medical Association (JAMA).
Although human rights abuses have been reported in Iraq, the full scope of these abuses has not been well documented, according to background information in the article.
Lynn L. Amowitz, M.D., M.S.P.H., M.Sc., of the Physicians for Human Rights, Boston, and colleagues conducted a study to assess the nature and scope of human rights abuses in southern Iraq since 1991 and to examine Iraqi views on women's health and human rights. The study consisted of a survey of 1,991 Iraqi men and women, representing 16,520 household members in three major cities in southern Iraq. The survey was conducted in July 2003, using structured questionnaires.
Respondents averaged 38 years of age, and were mostly of Arab ethnicity (99.7 percent) and Muslim Shi'a (96.7 percent). "Overall, 47 percent of those interviewed reported 1 or more of the following abuses among themselves and household members since 1991: torture, killings, disappearance, forced [military service], beating, gunshot wounds, kidnappings, being held hostage, and ear amputation, among others. Seventy percent of abuses were reputed to have occurred in homes. Baath party regime-affiliated groups were identified most often (95 percent) as the perpetrators of the abuses; 53 percent of the abuses occurred between 1991 and 1993, following the Shi'a uprising, and another 30 percent between 2000 and the first 6 months of 2003," the authors write.
"Education and work opportunities for women were both highly supported by men and women. However, men were significantly less supportive than women of these rights and of women's civil and political rights. Half of respondents agreed that there were reasons to restrict women's educational opportunities (53 percent) and work opportunities (50 percent) outside the home at the present time. Both men and women were less likely to support women's rights to associate with persons of their choosing and to be able to move about in public without restrictions," the researchers write. The authors also found that more than half of both men and women agreed that a man had a right to beat his wife if she did not obey him.
Respondents support an Iraqi society that protects and promotes human rights, but neither men nor women support a full range of human rights for women.
(JAMA. 2004;291:1471-1479. Available post-embargo at jama.com)
Editor's Note: The survey was made possible by a grant from the John D. and Catherine T. MacArthur Foundation.
IRAQI PHYSICIANS REPORT ON PHYSICIAN PARTICIPATION IN HUMAN RIGHTS ABUSES
About half of Iraqi physicians surveyed indicate that some physicians have participated in a variety of human rights abuses in Iraq, including physical mutilation and falsification of reports regarding torture, according to a study in the March 24/31 issue of JAMA.
According to background information in the article, although the participation of physicians in human rights abuses in Iraq during the Baath regime has been documented, Iraqi physicians have not, to the authors' knowledge, been surveyed about their own experiences and views on physician involvement.
Chen Reis, J.D., M.P.H., of the Physicians for Human Rights, Boston, and colleagues conducted a survey of physicians in southern Iraq to assess patterns and practices of physician participation in human rights abuses and identified factors that facilitated physician participation in these abuses.
The study consisted of a self-administered survey in June and July, 2003, of 98 physicians and semistructured interviews of hospital directors and physicians in 3 major hospitals with general surgical units in 2 cities in southern Iraq. The majority of participants were male (88 percent) and Shi'a Muslims (97 percent). Respondents had an average of 6.8 years in practice.
"A total of 71 percent of respondents reported that torture was a problem to an extreme extent in Iraq since 1988. The proportion of respondents indicating that, since 1988, their physician peers as a group were extremely or quite a bit involved in human rights abuses included 50 percent for nontherapeutic amputation of ears as a form of punishment, 49 percent for falsification of medical-legal reports of torture, and 32 percent for falsification of death certificates. Few respondents (range, n=2 to 6) reported participation in abuses themselves.
"More than half (52 percent) of respondents indicated that physicians did not willingly participate in these abuses; 93 percent reported that the Iraqi paramilitary force Fedayeen Saddam was responsible for initiating physician complicity. Fear of harm to oneself or family members was a common explanation for complicity. Respondents reported that physicians who refused to participate in abuses faced consequences including loss of job, imprisonment, torture, and disappearance," the researchers write.
Measures suggested to prevent physician involvement in future abuses included ensuring the independence of physicians from state authorities, legal provisions to ensure effective monitoring, punitive sanctions for physicians who commit abuses, and increasing human rights and ethics education of physicians.
(JAMA. 2004;291:1480-1486. Available post-embargo at jama.com)
Editor's Note: This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation.
EDITORIAL: MEDICAL ETHICS SUBORNED BY TYRANNY AND WAR
In an accompanying editorial, Edmund D. Pellegrino, M.D., of the Center for Clinical Bioethics, Georgetown University Medical Center, Washington, D.C., examines the studies on human rights abuses in Iraq in this week's JAMA."
"The central problem in the case of Iraqi physicians who have engaged in torture and other abuses is the active and passive collusion of the profession with patriotic and defensive measures justified in the interest of the nation, one's career, or personal safety," he writes. "The study by Reis et al shows again that national and international medical associations must examine more closely the implications of becoming instruments of anything other than the healing purposes for which the profession is ordained."
Concerning the study by Amowitz et al, "Given these findings, it may not be surprising that some Iraqi physicians were acclimated and relatively insensitive to the moral implications of violence, especially against purported enemies of the Baath regime. Both of the articles on human rights abuses in Iraq published in this issue of THE JOURNAL alert the world to the continuing violation of the most fundamental human rights. Even though the United Nations declaration is now 50 years old, it risks becoming little more than a pious and self-righteous travesty if an orderly yet firm international means for enforcement is not found," he concludes.
(JAMA. 2004;291:1505-1506. Available post-embargo at jama.com)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org
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EMBARGOED FOR RELEASE: 3 P.M. CT, TUESDAY, March 23, 2004
Media Advisory: To contact Arthur J. Barsky, M.D., call Amy Dayton at 617-534-1603.
COGNITIVE BEHAVIOR THERAPY EFFECTIVE FOR TREATING PEOPLE WITH HYPOCHONDRIA
CHICAGO—Patients with a persistent fear or belief that they have a serious, undiagnosed illness significantly reduced their symptoms and anxieties by participating in therapy sessions which examined possible factors for their fears, according to a study in the March 24/31 issue of the American Medical Association (JAMA).
Hypochondriasis occurs in as many as 5 percent of medical outpatients, and can be a disabling and chronic condition. Hypochondriasis generally has not been responsive to psychological and pharmacological treatment and is costly for the health care system, according to background information in the article. Until recently, no specific treatment has been clearly demonstrated to be effective.
Arthur J. Barsky, M.D., and David K. Ahern, Ph.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, examined whether cognitive behavior therapy (CBT) would alleviate the symptoms of hypochondriasis more effectively than medical care as usual.
The CBT consisted of six individually administered 90-minute sessions at weekly intervals. Each session was tightly scripted and devoted to 1 of 5 factors that cause patients to amplify symptoms and misattribute them to serious disease: attention and bodily hypervigilance, beliefs about symptom etiology, circumstances and context, illness and sick role behaviors, and mood. Each session consisted of educational information about the symptom amplifiers, an illustrative exercise, and a discussion to personalize the material presented. The CBT was accompanied by a consultation letter sent to the patient's primary care physician. Participants were recruited from primary care practices and from volunteers responding to public announcements.
The study, conducted between September 1997 and November 2001, included 102 individuals who were assigned to CBT and 85 who were assigned to medical care as usual. Participants were assessed immediately before and 6 and 12 months after the completion of treatment.
"Using an intent-to-treat analytic strategy, a consistent pattern of statistically and clinically significant treatment effects was found at both 6-and 12-month follow-up, adjusting for baseline covariates that included educational level, generalized psychiatric distress, and participant status (patient vs. volunteer)," the authors write. "At 12-month follow-up, CBT patients had significantly lower levels of hypochondriacal symptoms, beliefs, and attitudes and health-related anxiety. They also had significantly less impairment of social role functioning and intermediate activities of daily living."
(JAMA. 2004;291:1464-1470. Available post-embargo at jama.com)
Editor's Note: This investigation was supported by a research grant from the National Institute of Mental Health.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org
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JAMA REPORTS
HYSTERECTOMY VS. MEDICAL TREATMENTS
VIDEO:
B-roll: Shots of generic women on the street (Unidentifiable)
Shot of women in exam room
AUDIO:
WHY ARE SO MANY WOMEN IN THE U.S. GETTING HYSTERECTOMIES? MORE THAN
600-THOUSAND WOMEN EACH YEAR ARE HAVING THEM DONE, MAKING HYSTERECTOMIES THE
MOST COMMON MAJOR SURGERY PERFORMED FOR NON-OBSTETRIC REASONS.
VIDEO:
SOT/FULL
Super @:13
Miriam Kuppermann, Ph.D., M.P.H., Health Researcher, University of
California, San Francisco
AUDIO:
"In the last decade there have been questions raised regarding the
appropriate use of hysterectomy and specifically whether this procedure
might be done a little too frequently."
VIDEO:
B-roll: Shots of Dr. Kuppermann with Dr. Learman looking over papers
GFX: JAMA cover
AUDIO:
DR. MIRIAM KUPPERMANN AND SEVERAL COLLEAGUES AT THE UNIVERSITY OF
CALIFORNIA, SAN FRANCISCO STUDIED HYSTERECTOMIES COMPARED WITH MEDICAL
TREATMENTS TO FIND OUT WHICH GAVE PATIENTS A BETTER QUALITY OF LIFE AT THE
END OF TWO YEARS. THEIR FINDINGS ARE PUBLISHED IN THIS WEEK'S JOURNAL OF
THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Miriam Kuppermann, Ph.D., M.P.H., Health Researcher, University of
California, San Francisco
AUDIO:
"The results of our study suggest that both hysterectomy and expanded
medical treatment are viable and reasonable approaches for a woman who has
abnormal uterine bleeding that has not been effectively controlled with her
first medicine."
VIDEO:
B-roll: Shots of women freeze into gfx:
GFX: "Abnormal Uterine Bleeding"
More than 7 days of flow per month
Or
Anemia due to heavy periods
AUDIO:
THE WOMEN IN THE STUDY HAD ABNORMAL UTERINE BLEEDING, DEFINED AS MORE THAN
SEVEN DAYS OF FLOW PER MONTH OR ANEMIA DUE TO HEAVY PERIODS, FOR AN AVERAGE
OF FOUR YEARS. THE RESULTS SHOW BOTH COURSES OF TREATMENT TO BE HELPFUL.
VIDEO:
SOT/FULL
Super @ 1:08
Lee A. Learman, M.D., Ph.D., Obstetrician/Gynecologist, University of
California, San Francisco
AUDIO:
"If they choose to have a hysterectomy after one common medical treatment
has failed they can expect excellent improvements in quality of life over
two years of follow-up. However if they do not want to have a hysterectomy
and they can stick with expanded treatments with medication for two years
than they can also expect substantial improvement from where they started."
VIDEO:
B-roll: Shots of generic women
AUDIO:
THE QUESTION MAY BE IF WOMEN CAN WAIT THAT LONG. IN THE END HALF OF THE
WOMEN IN THE MEDICAL TREATMENT GROUP ELECTED TO HAVE A HYSTERECTOMY.
THIS IS LAURA MEEHAN REPORTING.
