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, August 23, 2005)
JAMA NEWS RELEASES
STUDY DOES NOT SUPPORT USE OF ANESTHESIA AS HEROIN WITHDRAWAL METHOD
LONG-TERM, REGULAR ASPIRIN USE ASSOCIATED WITH SIGNIFICANT REDUCTION IN COLORECTAL CANCER RISK AMONG WOMEN
DIAGNOSTIC STRATEGY MAY HELP DETERMINE STAGE OF LUNG CANCER MORE ACCURATELY
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
ASPIRIN AND RELATED DRUGS LINKED TO REDUCTION IN COLON CANCER RISK
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TV Note: This week's JAMA video news release is on the long-term use of aspirin and the risk of colorectal cancer. The release will be fed Tuesday, August 23, 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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September 16-18, Chicago
JAMA and BMJ will host the 5th International Congress on Peer Review and Biomedical Publication. New research will be released on topics including clinical trial registries, conflict of interest, scientific misconduct, bias in funding and sponsorship, and reporting clinical trials. For more information, go to www.jama-peer.org. To register, go to www.jamamedia.org and click on Events; email mediarelations{at}jama-archives.org; or call 312-464-JAMA (5262).
September 20, New York
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Embargoed for Release: 3 p.m. CT, Tuesday, August 23, 2005
Media Advisory: To contact Eric D. Collins, M.D., call Elizabeth Streich at 212-305-6535.
To contact editorial author Patrick G. O'Connor, M.D., M.P.H., call Karen Peart at 203-432-1326.
STUDY DOES NOT SUPPORT USE OF ANESTHESIA AS HEROIN WITHDRAWAL METHOD
CHICAGO—The use of general anesthesia for heroin detoxification offers no benefit when compared to two other methods, and is associated with several potentially life-threatening adverse events, according to an article in the August 24/31 issue of JAMA.
Heroin dependence remains a significant public health problem in the United States, according to background information in the article. Most of the approximately 1 million heroin-dependent individuals in the United States are not in treatment. Their main initial contact with the treatment system is often detoxification. Medically supervised heroin withdrawal remains plagued by patient discomfort and high dropout rates. Many patients fear the physical discomfort of withdrawal and either avoid treatment or leave it prematurely.
Even those who complete the detoxification process have high relapse rates, partly due to the absence of continuing treatment. These problems have given rise, in the past 15 years, to ultra-rapid, or anesthesia-assisted opioid detoxification, which involves administering an opioid antagonist drug to neutralize the effects of heroin while the patient is unconscious from general anesthesia. This has been publicized as a fast, painless way to withdraw from heroin. However, this treatment is expensive (as much as $15,000 in 2005), not covered by insurance, and lacks good evidence to support efficacy. There are also significant concerns about health risks. The detoxification procedure is usually followed by longer term treatment with an antagonist drug such as naltrexone to block the effects of any subsequent heroin use.
Eric D. Collins, M.D., of Columbia University, New York, and colleagues conducted a randomized controlled trial between 2000 and 2003 to evaluate the safety, tolerability, and efficacy of anesthesia-assisted rapid opioid detoxification compared with two other inpatient withdrawal and naltrexone treatment procedures. The study included 106 treatment-seeking heroin-dependent patients, aged 21 through 50 years, who were randomly assigned to 1 of 3 inpatient withdrawal treatments over 72 hours followed by 12 weeks of outpatient naltrexone maintenance with relapse prevention psychotherapy. Patients received either anesthesia-assisted rapid opioid detoxification (for 4 to 6 hours) with naltrexone induction, rapid opioid detoxification with buprenorphine (an opioid substitute) followed by naltrexone induction, or treatment with clonidine (an antihypertensive drug that decreases withdrawal symptoms) followed by delayed naltrexone induction.
The researchers found that average withdrawal severities were comparable across the 3 treatments. Compared with clonidine-assisted detoxification, the anesthesia- and buprenorphine-assisted detoxification interventions had significantly greater rates of naltrexone induction (94 percent for anesthesia, 97 percent for buprenorphine, and 21 percent for clonidine), but the groups did not differ in rates of completion of inpatient detoxification. Treatment retention over 12 weeks was low and not significantly different among the three groups. Overall, only 11 percent of patients continued in treatment for 12 weeks and had less than two opioid-positive urine tests, indicating a high rate of relapse to heroin use. The anesthesia procedure was associated with 3 potentially life-threatening adverse events: severe pulmonary edema and aspiration pneumonia; diabetic ketoacidosis, and a bipolar mixed state requiring hospitalization.
"In summary, this randomized trial of general anesthesia for opioid withdrawal and naltrexone induction demonstrates no benefit of anesthesia over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment. Taken together with the results of earlier studies, our findings suggest that general anesthesia for rapid antagonist induction does not currently have a meaningful role to play in the treatment of opioid dependence," the authors conclude.
(JAMA. 2005;294:903-913. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For Funding/Support and Financial Disclosure information, please see the JAMA article.
EDITORIAL: METHODS OF DETOXIFICATION AND THEIR ROLE IN TREATING PATIENTS WITH OPIOID DEPENDENCE
In an accompanying editorial, Patrick G. O'Connor, M.D., M.P.H., of the Yale University School of Medicine, New Haven, Conn., comments on the study and the broader issue of the role of detoxification in treating opioid dependence.
"The study by Collins et al in this issue of JAMA contributes significantly to the growing body of evidence concerning effective and safe treatment for opioid dependence by further documenting that anesthesia-assisted opioid detoxification is no more effective than opioid detoxification without anesthesia and that it can be unsafe. Thus, anesthesia-assisted detoxification should have no significant role in the treatment of opioid dependence. When detoxification is provided to patients, other approaches using clonidine, methadone, or buprenorphine are likely to be at least as effective as anesthesia-assisted detoxification and also are safer and far less costly."
"In the larger context of treating opioid dependence, the major implication of the overall results of this study and other studies is that regardless of the protocol used, detoxification-based treatment of opioid dependence has a low likelihood of long-term success for most opioid-dependent patients. Further research on detoxification-based treatment should focus on how to provide effective relapse prevention treatment. In the meantime, for the majority of individuals with chronic relapsing opioid dependence, opioid maintenance using methadone or buprenorphine is much more effective than detoxification in terms of decreasing drug use, supporting treatment retention, improving health outcomes, and improving social functioning. Thus, maintenance therapy should be considered first-line treatment for such patients," Dr. O'Connor writes.
(JAMA. 2005;294:961-963. Available pre-embargo to the media at www.jamamedia.org)
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, August 23, 2005
Media Advisory: To contact Andrew T. Chan, M.D., M.P.H., call Sue McGreevey at 617-724-2764.
LONG-TERM, REGULAR ASPIRIN USE ASSOCIATED WITH SIGNIFICANT REDUCTION IN COLORECTAL CANCER RISK AMONG WOMEN
CHICAGO—Women who took two or more aspirin or NSAIDs per week for more than 10 years significantly reduced their risk of colorectal cancer, according to an article in the August 24/31 issue of JAMA.
Recent randomized intervention trials have demonstrated that regular use of aspirin in patients with a history of colorectal adenoma (benign tumor) or cancer reduces the risk of recurrent adenoma within 1 to 3 years, according to background information in the article. However, whether long-term use of aspirin similarly reduces the risk of colorectal cancer and, if so, at what dose, has been unclear.
Andrew T. Chan, M.D., M.P.H., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues examined the influence of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) on the risk of colorectal cancer in a large group of women. The study included 82,911 women, enrolled in the Nurses' Health Study, who have been providing data on medication use biennially since 1980 and followed up through June 1, 2000.
Over the 20-year period, 962 cases of colorectal cancer were documented. Among women who regularly used aspirin (2 or more standard [325-mg] tablets per week), there was a 23 percent reduced relative risk for colorectal cancer compared with nonregular users. However, significant risk reduction was not observed until more than 10 years of use. The benefit appeared related to dose: compared with women who reported no use, the relative risk for cancer was 10 percent greater for women who used 0.5 to 1.5 standard aspirin tablets per week; 11 percent lower with 2 to 5 aspirin per week; 22 percent lower with 6 to 14 aspirin per week; and 32 percent lower with more than 14 aspirin per week. Women who took more than 14 aspirin per week for longer than 10 years had a 53 percent lower relative risk for colorectal cancer. A similar dose-response relationship was found for nonaspirin NSAIDs.
The incidence of reported major gastrointestinal bleeding events per 1000 person-years also appeared to be dose-related: 0.77 among women who denied any aspirin use; 1.07 for 0.5 to 1.5 standard aspirin tablets per week; 1.07 for 2 to 5 aspirin per week; 1.40 for 6 to 14 aspirin per week; and 1.57 for more than 14 aspirin per week.
"Our study supports a possible role for aspirin in cancer prevention, which has been demonstrated by prior adenoma recurrence trials. However, any substantial impact of aspirin on cancer necessitates early initiation and prolonged, consistent use. Moreover, optimal chemoprevention may require substantially higher doses of aspirin than currently recommended for the prevention of cardiovascular disease. Many toxicities of aspirin, including gastrointestinal bleeding, are dose-dependent. Thus, future studies will need to thoroughly consider the risk-benefit profile for aspirin/NSAID chemoprevention among various risk groups and compare such a strategy with other potential prevention efforts," the authors conclude.
(JAMA. 2005;294:914-923. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Cancer Institute, National Institutes of Health. Dr. Chan is a recipient of the American Gastroenterological Association/Foundation for Digestive Health and Nutrition Research Scholar Award and a career development award 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, August 23, 2005
Media Advisory: To contact Jouke T. Annema, M.D., Ph.D., email: j.t.annema{at}lumc.nl.
DIAGNOSTIC STRATEGY MAY HELP DETERMINE STAGE OF LUNG CANCER MORE ACCURATELY
CHICAGO—A preoperative testing strategy combining two procedures may help improve the accuracy of determining the stage of lung cancer, according to an article in the August 24/31 issue of JAMA.
Up to 40 percent of thoracotomies (surgical incision of the chest wall often involving surgery of the lung) performed for non-small cell lung cancer (NSCLC) are reported to be unnecessary, predominantly due to inaccurate preoperative detection of lymph node metastases, according to background information in the article. Accurate preoperative staging is important in identifying those patients who will benefit from surgical resection (removal of tissue). Currently available staging techniques have limited accuracy in selecting those lung cancer patients without regional lymph node metastases.
Transesophageal ultrasound-guided fine needle aspiration (removal of cells or tissue through a needle) (EUS-FNA) is a minimally invasive and safe technique than can target different lymph node stations and is complementary to mediastinoscopy (examination of the mediastinum [a part of the middle of the thoracic cavity] using a special scope that is inserted through an incision above the sternum) in its diagnostic reach. With EUS-FNA, an ultrasound transducer (a transmitter and receiver of ultrasound information) incorporated on top of an endoscope enables the investigator to visualize and insert the aspiration needle into mediastinal lymph nodes under real-time ultrasound guidance. The EUS-FNA examination has a sensitivity of 88 percent and a specificity of 91 percent in analyzing mediastinal lymph nodes. To date it is not known how EUS-FNA compares with mediastinoscopy, nor to what extent the combination of EUS-FNA and mediastinoscopy improves preoperative staging.
Jouke T. Annema, M.D., Ph.D., of Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a study to determine whether lung cancer staging by EUS-FNA in addition to mediastinoscopy improved preoperative staging compared with staging by mediastinoscopy alone. During a 3-year period (2000-2003), 107 patients with potential resectable non-small cell lung cancer underwent preoperative staging by both EUS-FNA and mediastinoscopy. Patients underwent thoracotomy with tumor resection if mediastinoscopy was negative. Surgical-pathological staging was compared with preoperative findings and the added benefit of the combined strategy was assessed. The multicenter study was performed in 1 referral and 5 general hospitals in the Netherlands.
The researchers found that the combination of EUS-FNA and mediastinoscopy identified more patients with tumor invasion or lymph node metastases (36 percent) compared with either mediastinoscopy alone (20 percent) or EUS-FNA (28 percent) alone. This indicated that 16 percent of thoractomies could have been avoided by using EUS-FNA in addition to mediastinoscopy. However, 2 percent of the EUS-FNA findings were false-positive.
"The results can be explained by the fact that EUS-FNA and mediastinoscopy have a complementary reach in assessing regional lymph node stations and in the ability of EUS-FNA to detect mediastinal tumor invasion," the authors write. "Our findings are directly applicable to clinical practice."
"Overall, mediastinoscopy and EUS-FNA have inherent limitations and they should be viewed as complementary in the regional staging of NSCLC. These preliminary findings suggest that EUS-FNA, a novel, minimally invasive staging procedure for lung cancer, may improve the preoperative staging due to the complementary reach of EUS-FNA in detecting mediastinal lymph node metastases and the ability to assess mediastinal tumor invasion. However, the occurrence of false-positive EUS-FNA findings in selected cases needs to be further investigated," the researchers conclude.
(JAMA. 2005;294:931-936. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The research for this article was supported by a grant from the Leiden University Medical Center. Hitachi Ultrasound (Reeuwijk, the Netherlands) provided the ultrasound scanner and echoendoscope on a loan basis.
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
ASPIRIN AND RELATED DRUGS LINKED TO REDUCTION IN COLON CANCER RISK
VIDEO:
SOT/FULL
@ :01
Super: Priscilla Groves
Has colon cancer
Runs :07
AUDIO:
"I was getting episodes of severe pain and vomiting over and over which would last about 8, 10 hours."
VIDEO:
B-ROLL
Priscilla watering plants outside
Priscilla with aspirin bottle/tablets
Priscilla with NSAID bottle/tablets
AUDIO:
THAT’S HOW 56-YEAR OLD PRISCILLA GROVES FOUND OUT SHE HAD COLON CANCER A YEAR AGO. RESEARCHERS WANTED TO KNOW HOW THEY COULD PREVENT OTHERS FROM GETTING COLON CANCER. PAST STUDIES HAD HINTED THAT ASPIRIN COULD HELP, AND PERHAPS, SO COULD NON-STEROIDAL ANTI-INFLAMMATORY DRUGS, KNOWN AS N-SAIDS, SUCH AS IBUPROFEN.
VIDEO:
SOT/FULL
@ :25
Super: Andrew Chan, M.D., M.P.H.
Massachusetts General Hospital
Runs :12
AUDIO:
"We did find that the regular use of aspirin and NSAIDS was associated with a reduced risk of colorectal cancer. However, it appeared that it really required prolonged consistent use of over a decade before we saw significant benefit."
VIDEO:
B-ROLL
Pouring pills into hand
AUDIO:
IN FACT, IT TOOK AT LEAST TEN YEARS OF TAKING A LOT OF PILLS.
VIDEO:
SOT/FULL
Andrew Chan, M.D., M.P.H.
Massachusetts General Hospital
Runs :13
AUDIO:
"It was the highest doses of aspirin and NSAIDS that were needed to prevent colorectal cancer. Specifically for aspirin, it really required more than 14 standard adult aspirin tablets per week to really realize the maximal benefit."
VIDEO:
B-ROLL
Dr. Chan and colleagues looking at computer screen of polyp removal
GFX/JAMA COVER
Priscilla looking at photo album
Photo of son
AUDIO:
DR. ANDREW CHAN AND COLLEAGUES AT MASSACHUSETTS GENERAL HOSPITAL STUDIED TWENTY YEARS OF HEALTH DATA ON MORE THAN 80-THOUSAND WOMEN TO SEE IF THESE MEDICATIONS AFFECTED COLON CANCER RISK. THE FINDINGS, PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SOUND LIKE GOOD NEWS TO PRISCILLA, WHO WORRIES ABOUT HER SON GETTING COLON CANCER.
VIDEO:
SOT/FULL
Priscilla Groves
Has colon cancer
Runs :06
AUDIO:
"I would think it would be something that, maybe it should just be a part of everyone’s regimen to do it unless you have a problem with your stomach and can’t do it."
VIDEO:
B-ROLL
Boxes on store shelves
AUDIO:
THAT’S A REAL CONCERN. WOMEN WHO TOOK MORE THAN 14 TABLETS A WEEK FOR TEN YEARS DID REDUCE THEIR RISK OF COLON CANCER BY HALF. BUT THE RESEARCHERS FOUND THAT ALL THOSE TABLETS ALSO CAUSED A GREATER RISK OF BLEEDING IN THE STOMACH AND INTESTINES.
VIDEO:
SOT/FULL
Andrew Chan, M.D., M.P.H.
Massachusetts General Hospital
Runs :12
AUDIO:
"It would be nice to develop a pill that people could take to prevent cancer. At this point, I don’t think we have that. I think we have a lot of research that suggests we’re getting closer to that point."
VIDEO:
B-ROLL
Capsules being poured
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
