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.

JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, June 21, 2005)

JAMA NEWS RELEASES

   ANTIBIOTICS APPEAR TO HAVE LITTLE BENEFIT FOR UNCOMPLICATED LOWER RESPIRATORY TRACT INFECTIONS

   FOR INDIVIDUALS WITH FAMILY HISTORY OF LUNG CANCER, RISK GREATER FOR BLACKS THAN WHITES

   ENDOCARDITIS INFECTION COMMONLY RELATED TO HEALTH CARE FACTORS, INCREASINGLY DUE TO STAPH

JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)

   VIDEO: Windows Media | Quicktime

   LUNG CANCER RISK GREATER FOR THOSE WITH CLOSE FAMILY HISTORY OF LUNG CANCER — RISK GREATER FOR BLACKS THAN FOR WHITES

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TV Note: This week's JAMA video news release is on the risk of lung cancer among white and African American relatives of individuals with early-onset lung cancer. The release will be fed Tuesday, June 21, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 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, June 21, 2005
Media Advisory: To contact Paul Little, M.D., email: p.little{at}soton.ac.uk. To contact editorialist Mark H. Ebell, M.D., M.S., call Tom Oswald at 517-432-0920.

CHICAGO—Patients with uncomplicated lower respiratory tract infections, such as bronchitis, who were given antibiotics had little difference in symptom relief compared to patients who did not receive antibiotics, according to a study in the June 22/29 issue of issue of JAMA.

Acute lower respiratory tract illness is the most common condition treated in primary care, according to background information in the article. In the United States, excess antibiotic prescribing is mainly for pharyngitis and acute bronchitis, amounting to 55 percent of prescriptions and costing $726 million per year. A consensus has been made for limiting antibiotic use in acute lower respiratory tract infection. However, recent reviews have come to diverse conclusions about the likely effectiveness of antibiotics and a recent review confirms a moderate effect of antibiotics on illness course; the debate continues unabated about the role of antibiotics because these reviews are relatively small. There are also concerns about complications if antibiotics are not prescribed and debate about which clinical characteristics identify those patients at higher risk.

The relative importance of prescribing strategies and information about natural history is also unclear. Preliminary evidence suggests that provision of an information leaflet can affect return rate and antibiotic use in lower respiratory tract infection, although the effect on symptomatic management of such a simple leaflet and whether a leaflet provides additional benefit to simple verbal information remains unclear.

Paul Little, M.D., of the University of Southampton, Highfield, England, and colleagues conducted a study to assess the effectiveness of three different antibiotic prescribing strategies on symptoms, beliefs, and behavior and to assess the effectiveness of an information leaflet compared with brief verbal information alone. The randomized controlled trial, conducted from August 1998 to July 2003, included 807 patients who presented to a primary care setting and had acute uncomplicated lower respiratory tract infection. Patients were assigned to 1 of 6 groups: information leaflet or no leaflet and 1 of 3 antibiotic groups (no offer of antibiotics [n=273], a delayed antibiotic prescription [n=272], and immediate antibiotics prescribed [n=262]). Approximately half of each group received an information leaflet (129 for immediate antibiotics, 136 for delayed antibiotic prescription, and 140 for no antibiotics).

A total of 562 patients (70 percent) returned complete diaries and 78 (10 percent) provided information about both symptom duration and severity. The researchers found that cough rated at least "a slight problem" lasted an average 11.7 days (25 percent of patients had a cough lasting 17 days or more). An information leaflet had no effect on the main outcomes. Compared with no offer of antibiotics, other strategies did not alter cough duration (delayed 0.75 days; immediate 0.11 days) or other primary outcomes. Compared with the immediate antibiotic group, slightly fewer patients in the delayed and control groups used antibiotics (96 percent, 20 percent, and 16 percent, respectively), fewer patients were "very satisfied" (86 percent, 77 percent, and 72 percent, respectively), and fewer patients believed in the effectiveness of antibiotics (75 percent, 40 percent, and 47 percent, respectively).

"In conclusion, in our patients from primary care who presented with acute uncomplicated lower respiratory tract infection, the use of delayed antibiotics or no antibiotics was acceptable, resulted in little difference in duration or severity of symptoms compared with immediate treatment with antibiotics, and considerably reduced both antibiotic use and belief in antibiotics. These findings suggest that adopting these strategies would help limit the vicious circle of the medicalization of self-limiting illness when antibiotics are prescribed. Immediate antibiotic prescribing is likely to limit the number of patients who return for cough within the next month but only by a little more than delayed antibiotic prescription. The challenge now is for clinicians and researchers to determine which groups are at risk of adverse outcomes and identify those patients who might selectively benefit from immediate antibiotic prescription," the researchers write.
(JAMA. 2005;293:3029-3035. Available post-embargo at jama.com)

Editor's Note: This study was supported by the Medical Research Council. Dr. Little has received consultancy fees for 2 half days from Abbott Pharmaceuticals regarding complications of respiratory infections. Co-author Mr. Watson was previously employed by the University of Southampton and is now currently an employee of GlaxoSmithKline. No other authors reported financial disclosures.

EDITORIAL: ANTIBIOTIC PRESCRIBING FOR COUGH AND SYMPTOMS OF RESPIRATORY TRACT INFECTION — DO THE RIGHT THING

In an accompanying editorial, Mark H. Ebell, M.D., M.S., of Michigan State University, East Lansing, Mich., comments on the findings of the study by Little et al.

"What can a clinician gain from the study by Little et al? First, antibiotics provide little or no benefit for patients with cough that is accompanied by lower respiratory tract symptoms provided the patient does not have pneumonia. This is true even for patients who are older and who have a low-grade fever or green sputum production. Second, physicians should be sure to inform patients that whether or not they take antibiotics, they can expect that a cough will last about 3 weeks, and that for at least 25 percent of patients it will last nearly a month. Third, by prescribing antibiotics it is clear that clinicians are training patients to expect these drugs. Physicians who feel compelled to give an antibiotic should at least use the tactic of delayed prescriptions to mitigate the effects of this prescribing error. Fourth, the patient's agenda for the visit must be addressed. Physicians should be sure to answer their questions, provide symptomatic care, and consider an inhaled beta-agonist if there is evidence of bronchospasm or a history of asthma."

"For patients in whom pneumonia is suspected, appropriate treatment must be promptly initiated. However, if the clinician does not suspect pneumonia, the patient should be informed of that assessment, but should be advised to return if symptoms progress. However, physicians should not give antibiotics to 100 patients on the chance that 1 patient may develop pneumonia at some point in the future," Dr. Ebell writes.

"In the current market-based health care system, it is tempting to confuse patient satisfaction with better outcomes, and to confuse more care with better quality care. Physicians have a duty to listen carefully to patients' symptoms, to examine them carefully, and to take the time to explain their illness to them. However, physicians have no duty to fulfill patients expectations for inappropriate care, such as prescribing antibiotics when they are not indicated, and must be mindful of the duty to the larger community that suffers financially and medically when antibiotics are overused," Dr. Ebell concludes.
(JAMA. 2005;293:3062-3064. 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, June 21, 2005
Media Advisory: To contact Michele L. Cote, Ph.D., call Jacqueline Trost at 313-576-8629.

FOR INDIVIDUALS WITH FAMILY HISTORY OF LUNG CANCER, RISK GREATER FOR BLACKS THAN WHITES

CHICAGO—First-degree relatives of black individuals with early-onset lung cancer have twice the risk of lung cancer than first-degree relatives of white individuals with early-onset lung cancer, according to a study in the June 22/29 issue of JAMA.

Cigarette smoking has long been established as the major risk factor for lung cancer in the general population, according to background information in the article. However, familial aggregation of disease (the concentration of cases of a disease in families), has also been identified as a risk factor. Greatest risk is seen in families with early-onset disease (less than 50 years at diagnosis) compared with those whose onset of lung cancer occurred at older ages. Researchers have determined that genetic predisposition to lung cancer exists. Approximately 173,770 new diagnoses of lung cancer were estimated to have occurred in the U.S. in 2004. Early-onset cases represent 6.7 percent of lung cancers diagnosed in the U.S.

Michele L. Cote, Ph.D., of Wayne State University, Detroit, and colleagues conducted a study to estimate the lifetime risk of lung cancer by race, smoking status, and family history of early-onset lung cancer. This information could be used to identify high-risk individuals and to counsel families with a history of early-onset lung cancer.

The researchers analyzed data from incident cases and controls that occurred between 1990 and 2003 in metropolitan Detroit. The study included 7,576 biological mothers, fathers, and siblings of 629 early-onset cases and 773 controls. One-third of the population was black.

The researchers found that relatives of black patients with early-onset lung cancer had more than twice (2.07) the risk of lung cancer compared with relatives of white patients with early-onset lung cancer after adjusting for age, sex, pack-years, pneumonia, and chronic obstructive lung disease.

"This finding could be the result of a higher degree of underlying susceptibility or aggregation of unmeasured risk factors for lung cancer in black families," the authors write.

The researchers also found that smokers with a family history of early-onset lung cancer in a first-degree relative had a higher risk of developing lung cancer with increasing age than smokers without a family history. An increase in risk occurs after age 60 years in these individuals, with 17.1 percent of white case relatives and 25.1 percent of black case relatives diagnosed with lung cancer by age 70 years.

"Family history assessment should be included when evaluating smokers or those presenting with symptoms consistent with lung disease. Further characterization of high-risk individuals is important to provide clinicians with counseling tools and to enhance the effectiveness of screening programs. Family history of early-onset lung cancer in a first-degree relative should be considered a risk factor in other relatives older than 18 years. As knowledge about risk factors (other than tobacco use) for lung cancer increases, physicians may be more likely to consider lung cancer as a differential diagnosis in their young patients. Earlier diagnosis and intervention may reduce mortality and morbidity in this population. Ongoing trials should evaluate the usefulness of screening modalities among those with a family history of early-onset lung cancer."
(JAMA. 2005;293:3036-3042. Available post-embargo at jama.com)

Editor's Note: This work was supported by a grant and contract from the National Cancer Institute.

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, June 21, 2005
Media Advisory: To contact Vance G. Fowler, Jr., M.D., M.H.S., call Becky Oskin at 919-684-4148. To contact the lead author of the 2^nd study, Imad M. Tleyjeh, M.D., call Lee Aase at 507-266-2442. To contact editorialist Vincent Quagliarello, M.D., call Karen Peart at 203-432-1326.

ENDOCARDITIS INFECTION COMMONLY RELATED TO HEALTH CARE FACTORS, INCREASINGLY DUE TO STAPH

CHICAGO—An international study reveals that infective endocarditis, infection and inflammation involving the heart valves is commonly associated with health care factors and is increasingly due to staphylococcal infection, according to a study in the June 22/29 issue of JAMA.

For decades, infective endocarditis (IE) caused by Staphylococcus aureus has been viewed primarily as a community-acquired disease, especially associated with injection drug use, according to background information in the article. Because no large, prospectively collected, and geographically diverse cohort of patients with IE existed before now, the global significance and impact of regional variations on the characteristics, treatment, and outcome of S aureus IE has not been known.

Vance G. Fowler, Jr., M.D., M.H.S., of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to document the characteristics of IE caused by S aureus, including IE associated with health care contact and IE due to methicillin-resistant S aureus (MRSA), in different parts of the world; and assessed regional differences and the effect of these differences on clinical outcomes among patients with S aureus IE. The study included 1,779 patients with IE from 39 medical centers in 16 countries. The patients were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to December 2003.

The researchers found that S aureus was the most common pathogen among the 1779 cases (558 patients, 31.4 percent). Health care-associated infection was the most common form of S aureus IE (218 patients, 39.1 percent), accounting for 25.9 percent (Australia/New Zealand) to 54.2 percent (Brazil) of cases. Most patients with health care-associated S aureus IE (131 patients, 60.1 percent) acquired the infection outside of the hospital. MRSA IE was more common in the United States (37.2 percent) and Brazil (37.5 percent) than in Europe/Middle East (23.7 percent) and Australia/New Zealand (15.5 percent). Patients in the United States were most likely to be hemodialysis dependent, to have diabetes, to have a presumed intravascular device source, to receive vancomycin, to be infected with MRSA, and to have persistent bacteremia.

"The finding of S aureus as the leading cause of IE differs from previous reports and may be due in part to increasing rates of staphylococcal bacteremia related to health care contact in industrialized nations," the authors write.

"S aureus is now the most common cause of IE in many areas of the developed world. Patients with IE due to S aureus exhibit distinct characteristics compared with patients with IE due to other pathogens. Health care-associated IE is emerging as the most common form of S aureus IE and has distinct features compared with more familiar forms of S aureus IE, such as community-acquired injection drug use-associated infection. MRSA is now encountered internationally as a relatively common cause of IE and is associated with persistent bacteremia. Future investigations are required to identify better treatment and prevention strategies for this serious and common consequence of medical progress," the authors conclude.
(JAMA.2005;293:3012-3021. Available post-embargo at jama.com)

Editor's Note: For funding/support and financial disclosure information, please see the JAMA article.

INCIDENCE OF INFECTIVE ENDOCARDITIS NOT DECREASING

Despite improvements in health care, the incidence of infective endocarditis in Minnesota has not decreased over 3 decades, according to a study in the June 22/29 issue of JAMA.

Limited data exist regarding population-based epidemiologic changes in incidence of infective endocarditis (IE), according to background information in the article.

Imad M. Tleyjeh, M.D., of Mayo Clinic, Rochester, Minn., and colleagues evaluated trends in the incidence and clinical characteristics of IE in a population-based cohort. The survey was from the Rochester Epidemiology Project of Olmsted County, Minnesota. One hundred seven IE episodes occurred in 102 Olmsted County residents between 1970 and 2000.

Olmsted County is considered an ideal site for a population-based study because the population is relatively isolated from urban centers; medical care is largely self-contained within the community; and medical records of all inpatient and outpatient care are available for study. However, "the population consists largely of middle-class whites, with a low prevalence of injection drug abuse," according to the authors.

"In this geographically defined community, the incidence of IE has remained stable during the past 3 decades. The adjusted incidence of IE ranged from 5.0 to 7.0 cases per 100,000 person-years," the authors write.

The researchers offer 2 potential factors why IE cases have not gone down over the past 30 years. "First, there may have been a true overall decline in IE incidence, which was concealed by a detection bias with better blood culture techniques and more frequent use of echocardiography. Second, an increase in incidence caused by a more frequent use of echocardiography may have been offset, in part, by a declining number of autopsy-diagnosed cases."
(JAMA. 2005;293:3022-3028. Available post-embargo at jama.com)

Editor's Note: This study was supported in part by grants from the Public Health Service and the National Institutes of Health.

EDITORIAL: INFECTIVE ENDOCARDITIS — GLOBAL, REGIONAL, AND FUTURE PERSPECTIVES

In an accompanying editorial, Vincent Quagliarello, M.D., of Yale University School of Medicine, New Haven, Conn., discusses the articles in this week's JAMA on endocarditis.

"What should practicing clinicians learn from the distinct observations of these 2 studies? Although endocarditis is relatively uncommon, it remains a persistent and serious clinical burden in local communities and around the globe. Moreover, in communities where injection drug use is uncommon, viridans streptococci remain a common underlying cause, despite well-known and distributed recommendations for antibiotic prophylaxis. In addition, with increasing insertion of intravascular devices, prosthetic valves, intravenous catheters for outpatient infusion therapy, and patient placement in long-term care facilities, there will be increasing opportunities for patients to become colonized and infected with S aureus, including MRSA. "

"Future educational efforts need to focus on adherence to infection control practices, appropriate antibiotic use, and improving selection of patients for valve surgery. Research efforts are needed to develop more effective bactericidal agents against MRSA and test new adjunctive treatments to reduce the biofilm-producing capabilities of Staphylococcus that make it such a difficult pathogen to eradicate," Dr. Quagliarello concludes.
(JAMA. 2005;293:3061-3062. Available post-embargo at jama.com)

Editor's Note: Dr. Quagliarello has served as a paid consultant to Pfizer and Cubist.

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

VIDEO: Windows Media | Quicktime

LUNG CANCER RISK GREATER FOR THOSE WITH CLOSE FAMILY HISTORY OF LUNG CANCER — RISK GREATER FOR BLACKS THAN FOR WHITES

VIDEO:
B-ROLL
George looking at photo album

AUDIO:
69-YEAR OLD GEORGE SMITH RECENTLY LEARNED HE HAS LUNG CANCER. AND HE’S NOT THE FIRST IN HIS FAMILY TO GET IT.

VIDEO:
SOT/FULL
@ :07
Super: George Smith
Has lung cancer
Runs :04

AUDIO:
"My brother came down with cancer about a year ago."

VIDEO:
B-ROLL
Picture of Alvin
C/u of picture
GFX/JAMA COVER
Researchers looking at lung cancer CT scans on light board

AUDIO:
HIS BROTHER, ALVIN, HAS SINCE DIED. SIBLINGS, PARENTS AND CHILDREN ARE CONDSIDERED FIRST-DEGREE RELATIVES. IN A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, WAYNE STATE UNIVERSITY RESEARCHERS LOOKED AT LUNG CANCER RISK AMONG PEOPLE WITH FIRST-DEGREE RELATIVES WHO GOT EARLY ONSET LUNG CANCER, MEANING BEFORE AGE FIFTY.

VIDEO:
SOT/FULL
@ :32
Super: Michele Cote, Ph.D.
Wayne State University researcher
Runs :10

AUDIO:
"What we found was overall, there was approximately a 2 fold increase in risk if you’re related to somebody who has early onset lung cancer."

VIDEO:
B-ROLL
White man smoking
Black girl smoking

AUDIO:
AND THAT RISK WAS GREATER AMONG SMOKERS… NOT A BIG SURPRISE. BUT RESEARCHERS WERE SURPRISED THAT THE RISK WAS GREATER AMONG BLACK FAMILIES, COMPARED TO WHITE.

VIDEO:
SOT/FULL
@ :51
Super: John Ruckdeschel, M.D.
Wayne State University researcher
Runs :08

AUDIO:
"For whites it’s about a 17 % risk of developing lung cancer, for African Americans it’s about 25 %, and those are pretty staggering risks of developing lung cancer."

VIDEO:
B-ROLL
White men smoking

AUDIO:
THOSE RISKS APPLY TO LONG-TERM SMOKERS WHO ALSO HAVE A FIRST-DEGREE RELATIVE WITH EARLY ONSET LUNG CANCER.

VIDEO:
SOT/FULL
Michele Cote, Ph.D.
Wayne State University researcher
Runs :06

AUDIO:
"There’s very likely a genetic component to risk, over and above the risk of smoking."

VIDEO:
B-ROLL
Black man smoking

AUDIO:
THIS POSSIBILITY MAY ACTUALLY HELP PEOPLE AT INCREASED RISK.

VIDEO:
SOT/FULL
Michele Cote, Ph.D.
Wayne State University researcher
Runs :15

AUDIO:
"If we can identify people who are at greater risk of lung cancer and encourage them to never start smoking or stop smoking, or enroll them into screening programs, we’ll be able to either prevent lung cancer in these individuals or identify lung cancers earlier on."

VIDEO:
B-ROLL
George with wife looking at photo album

AUDIO:
GEORGE’S RISK WAS GREAT. HE HAD THE FAMILY LINK, PLUS HE SMOKED HEAVILY FOR DECADES.

VIDEO:
SOT/FULL
George Smith
Has lung cancer
Runs :04

AUDIO:
"It’s a one-way street to cancer."

VIDEO:
B-ROLL
White men smoking
Empty ashtrays

AUDIO:
HE AND THE RESEARCHERS AGREE, QUITTING SMOKING, OR NOT STARTING, ARE THE BEST WAYS TO PREVENT LUNG CANCER. THIS IS MAVIS PRALL WITH THE JAMA REPORT.