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: 3:00 p.m. CT, Tuesday, June 13, 2006)
JAMA NEWS RELEASES
USE OF ANTI-DEPRESSANT DOES NOT DECREASE RISK OF RELAPSE FOR PATIENTS WITH ANOREXIA NERVOSA
CONSUMPTION OF FISH OIL DOES NOT APPEAR TO PROTECT AGAINST ABNORMAL HEART RHYTHMS FOR PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
STUDIES COMPARING USE OF MANUAL VS. AUTOMATED CHEST COMPRESSION FOLLOWING CARDIAC ARREST REACH DIFFERING CONCLUSIONS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
FLUOXETINE (PROZAC) IS NOT EFFECTIVE IN HELPING RECOVERING ANOREXIA PATIENTS MAINTAIN WEIGHT
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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TV Note: This week's JAMA video news release is on the effectiveness of an anti-depressant in treating anorexia nervosa. The release will be fed Tuesday, June 13, 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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Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, June 13, 2006
Media Advisory: To contact B. Timothy Walsh, M.D., call Dacia Morris at 212-543-5421. To contact editorial author Scott J. Crow, M.D., call Liz Bryan at 612-624-5680.
USE OF ANTI-DEPRESSANT DOES NOT DECREASE RISK OF RELAPSE FOR PATIENTS WITH ANOREXIA NERVOSA
CHICAGO—Use of the anti-depressant fluoxetine did not help patients with anorexia nervosa who had restored their body weight maintain that weight or reduce their risk of relapse, according to a study in the June 14 issue of JAMA.
Anorexia nervosa is an eating disorder primarily affecting young women and marked by an extreme fear of becoming overweight that leads to excessive dieting to the point of serious ill-health and sometimes death. It is a serious psychiatric illness with a lifetime death rate arguably as high as that associated with any psychiatric illness, according to background information in the article. A major contributor to the poor prognosis of this illness is the high rate of relapse, with 30 to 50 percent of patients requiring rehospitalization within 1 year of discharge after successful weight restoration. This has prompted interest in interventions aimed at preventing relapse following weight restoration. A substantial number of patients with anorexia nervosa receive antidepressant medications. Fluoxetine was initially marketed under the brand name of Prozac.
B. Timothy Walsh, M.D., of New York State Psychiatric Institute/Columbia University Medical Center, New York, and colleagues compared fluoxetine with placebo to determine the rate of relapse and behavioral recovery following initial treatment for anorexia nervosa. The trial included 93 patients with anorexia nervosa who had received intensive inpatient or day-program treatment and regained weight to a minimum body mass index (BMI) of 19.0. Participants were then randomly assigned to receive fluoxetine (n = 49) or placebo (n = 44) and were treated for up to 1 year as outpatients.
The researchers found that similar percentages of patients assigned to fluoxetine and to placebo maintained a BMI of at least 18.5 and remained in the study for 52 weeks (fluoxetine: 26.5 percent; placebo: 31.5 percent). The most conservative analysis of time-to-relapse found no significant difference between the fluoxetine and placebo groups in time-to-relapse. At 52 weeks, 45 percent of the placebo group and 43 percent of the fluoxetine group had not relapsed.
“The current study has implications for both clinical practice and research. The present findings, coupled with those of previously published studies, indicate that the common practice of prescribing antidepressant medication is unlikely to provide substantial benefit for most patients with anorexia nervosa, either when they are underweight or immediately upon weight restoration. These data imply that therapeutic efforts would be better devoted to psychological and behavioral interventions for which there is some, albeit modest, evidence of efficacy,” the authors write. “Future research on the utility of novel psychological treatments and innovative psychotropic and nonpsychotropic medications is obviously needed.”
(JAMA. 2006;295:2605-2612. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by grants from the National Institutes of Health. Eli Lilly supplied fluoxetine and placebo. For the financial disclosures of the authors, please see the JAMA article.
EDITORIAL: FLUOXETINE TREATMENT OF ANOREXIA NERVOSA — IMPORTANT BUT DISAPPOINTING RESULTS
In an accompanying editorial, Scott J. Crow, M.D., of the University of Minnesota, Minneapolis, comments on the findings of the study examining the use of fluoxetine for anorexia nervosa.
“The study by Walsh et al is an important contribution that addresses a major gap in research on anorexia nervosa and provides vital information about a fairly common treatment practice for this illness. Unfortunately, it appears that fluoxetine provides no benefit in the relapse prevention treatment of anorexia nervosa. Despite a prevalence rate similar to many other psychiatric illnesses, and particularly in light of the high mortality associated with anorexia nervosa, there is a serious underrepresentation of anorexia nervosa in biomedical research. Much more information is needed on the treatment of individuals with anorexia nervosa while they are at low weight. In addition, strategies must be developed to help individuals who recover to stay in recovery.”
(JAMA. 2006;295:2659-2660. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Crow reports having received research support from Eli Lilly, Abbott Laboratories, GlaxoSmithKline, Ortho McNeil Pharmaceuticals, Pfizer, and Bristol-Myers Squibb; consultant fees from Ortho McNeil Pharmaceuticals; and honoraria from Pfizer.
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: 3:00 p.m. CT, Tuesday, June 13, 2006
Media Advisory: To contact Ingeborg A. Brouwer, Ph.D., email: ingeborg.brouwer{at}wur.nl.
CONSUMPTION OF FISH OIL DOES NOT APPEAR TO PROTECT AGAINST ABNORMAL HEART RHYTHMS FOR PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR
CHICAGO—Patients with an implantable cardioverter defibrillator did not have a significantly lower risk of serious abnormal heart rhythms or death by consuming fish oil supplements, which had been thought to have a protective effect, according to a study in the June 14 issue of JAMA.
Sudden cardiac death is responsible for approximately 50 percent of all death from cardiovascular disease in the Western world. Epidemiological studies indicate that intake of very-long-chain n-3 polyunsaturated fatty acids (omega-3 PUFAs) as present in fish or fish oil is associated with a reduction in cardiovascular death, possibly by reducing susceptibility to cardiac arrhythmia, according to background information in the article. Recent trials on fish oil and ventricular arrhythmia (abnormal heart rhythm) in patients with implantable cardioverter defibrillators (ICDs; an electrical device that can correct an abnormal heart rhythm) yielded inconclusive results.
Ingeborg A. Brouwer, Ph.D., of Wageningen University, the Netherlands, and colleagues tested the effect of omega-3 PUFAs from fish on the incidence of recurrent ventricular arrhythmia and all-cause death in a large, placebo-controlled, randomized trial of patients with ICDs. The Study on Omega-3 Fatty acids and ventricular Arrhythmia (SOFA) was conducted at 26 cardiology clinics across Europe and included 546 patients with ICDs and prior documented ventricular tachycardia (VT) or ventricular fibrillation (VF) (both are types of serious cardiac arrhythmias). Patients were randomly assigned to receive 2 grams/day of fish oil in capsules (n=273) or placebo capsules (n=273) for a median (midpoint) period of 356 days.
In total, 75 patients (27 percent) in the fish oil group and 81 patients (30 percent) in the placebo group received appropriate ICD intervention for VT or VF. Event-free survival did not substantially improve in the fish oil group.
“In this large randomized trial we did not find evidence of strong protective effect of intake of omega-3 PUFAs from fish oil against ventricular arrhythmia in patients with ICDs. In contrast to others, we did not find that fish oil may have proarrhythmic properties,” the authors conclude.
(JAMA. 2006;295:2613-2619. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
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: 3:00 p.m. CT, Tuesday, June 13, 2006
Media Advisory: To contact Al Hallstrom, Ph.D., call Clare Hagerty at 206-685-1323. To contact the corresponding author of the 2nd study, Joseph P. Ornato, M.D., call Malorie Janis at 804-827-0889. To contact editorial co-author Roger J. Lewis, M.D., Ph.D., call Julie Rees at 310-222-2345, ext. 2106.
STUDIES COMPARING USE OF MANUAL VS. AUTOMATED CHEST COMPRESSION FOLLOWING CARDIAC ARREST REACH DIFFERING CONCLUSIONS
CHICAGO—Two studies comparing the use of manual chest compression vs. an automated chest compression device during resuscitation for out-of-hospital cardiac arrest produce contrasting findings, according to the studies in the June 14 issue of JAMA.
Out-of-hospital cardiac arrest claims hundreds of thousands of lives annually in North America. Successful resuscitation depends on a coordinated set of actions including early cardiopulmonary resuscitation (CPR), according to background information in the article. Observations of rescue personnel during CPR indicate that maintaining consistent chest compressions is a difficult task. The desire to provide optimal chest compressions led to the development of automated mechanical chest compression devices. The load-distributing band (LDB) is a circumferential chest compression device with an electrically activated constricting band on a short backboard and has been approved by the Food and Drug Administration for use in attempted resuscitation of cardiac arrest. Compared with manual chest compression, an automated LDB chest compression device produces greater blood flow to vital organs and may improve outcomes.
Al Hallstrom, Ph.D., of the University of Washington, Seattle, and colleagues conducted a study to compare LDB-CPR with manual CPR during out-of-hospital cardiac arrest. The multicenter, randomized trial included 1,071 patients who experienced out-of-hospital cardiac arrest in the United States and Canada. Patients received either standard emergency medical services (EMS) care for cardiac arrest with a LDB-CPR device (n = 554) or manual CPR (n = 517). The primary outcome measure included survival to 4 hours after the 911 call, with secondary measures being survival to hospital discharge and neurological status among survivors.
There was no significant difference in survival at 4 hours after the 911 call between the manual CPR group and the automated LDB-CPR group overall (29.5 percent vs. 28.5 percent) or among the primary study population (24.7 percent vs. 26.4 percent). Survival to hospital discharge was lower in the LDB-CPR group among primary episodes (5.8 percent vs. 9.9 percent), as was survival with intact neurological status.
“As implemented in this study, the use of an automated LDB-CPR device for resuscitation from out-of-hospital cardiac arrest appeared to result in lower survival and worse neurological outcomes than traditional manual CPR. Device design and implementation strategies may need further preclinical evaluation. The results of this study underscore the complexity of resuscitation from out-of-hospital cardiac arrest. Further work is required to understand the interaction of manual or assisted chest compressions with other aspects of resuscitation such as the phase of the arrest, drug choice and dose, timing of defibrillation, and treatments such as hypothermia and coronary reperfusion,” the authors conclude.
(JAMA. 2006;295:2620-2628. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was sponsored by Revivant Corporation, now part of the ZOLL Corporation. Co-author Dr. Mosesso reported receiving equipment and supplies for the AED clinical trial from the ZOLL Corporation.
STUDY FINDS BETTER PATIENT OUTCOMES FOR AUTOMATED COMPRESSION DEVICE COMPARED TO MANUAL COMPRESSION
In another study, Marcus Eng Hock Ong, M.D., M.P.H., of Virginia Commonwealth University, Richmond, Va., and colleagues compared resuscitation outcomes before and after an urban EMS system switched from manual CPR to LDB CPR. The study included an analysis of 783 adults with out-of-hospital, nontraumatic cardiac arrest. A total of 499 patients were included in the manual CPR phase and 284 patients in the LDB-CPR phase. Of these patients, the LDB device was applied in 210 patients.
The researchers found that the rates of return of spontaneous circulation and survival to hospital admission were all significantly higher in the LDB-CPR phase, after adjustment for differences in EMS response time intervals and EMS witnessed. Survival to hospital discharge was higher in the LDB-CPR phase than in the manual CPR phase (9.7 percent vs. 2.9 percent), and was significantly higher after adjustment for differences in EMS response time intervals, EMS witnessed, and postresuscitation hypothermia, but there was no significant difference between the groups in terms of neurologic outcomes among survivors.
“In our study, OHCA clinical outcomes were improved following the introduction of LDB into an urban EMS system. The benefit was relatively robust across a range of patient subsets, especially for those patients with ventricular fibrillation initially, bystander witnessed events, and recipients of bystander CPR,” the authors write.
“Our results suggest that a resuscitation strategy using the LDB CPR on rapidly responding EMS ambulances is associated with improved outcomes, including survival to hospital discharge, in adults with OHCA. These results suggest that the LDB device may be a useful addition to current cardiac arrest treatment options, especially when used early on patients with cardiac arrest who do not respond immediately to a brief period of manual CPR, defibrillation or both. However, further research (a large, adequately powered, prospective randomized clinical trial that blinds the rescuers to the intervention until they decide to initiate resuscitation) is needed to further define the value of LDB in resuscitation,” the researcher conclude.
(JAMA. 2006;295:2629-2637. 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: MANUAL VS. DEVICE-ASSISTED CPR - RECONCILING APPARENTLY CONTRADICTORY RESULTS
In an accompanying editorial, Roger J. Lewis, M.D., Ph.D., and James T. Niemann, M.D., of the Harbor-University of California Los Angeles Medical Center, Los Angeles, discuss the differences found in the studies comparing manual and automated chest compression for cardiac arrest.
“Can the differing conclusions of the 2 studies be reconciled? Although it is not possible to reach definitive conclusions until additional data are available, the best current information suggests that the degree of benefit or harm associated with use of the LDB-CPR device is influenced by the details of its use—perhaps including selection of the patient population with respect to presenting rhythm, time from cardiac arrest to initiation of CPR, and almost certainly time-to-deployment and the influence of deployment on time-to-defibrillation, when appropriate. To shed light on these questions, future comparative studies will need to pay particular attention to the definition and consistency of the method of use of the device, to measuring the multiple important time intervals with precision, and to ensuring the quality of the manual CPR administered in both trial groups.”
“Conducting high-quality clinical trials in patients with out-of-hospital cardiac arrest is extremely difficult because of the complexity of EMS systems, strong preconceived notions regarding effective therapies, and the almost ubiquitous presence of unmeasured confounding factors that profoundly influence outcomes for individual patients and treatment effects. However, only by aggressively identifying and rigorously testing promising new therapies will the outcomes improve for patients who experience sudden cardiac death.”
(JAMA. 2006;295:2661-2664. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. Lewis and Niemann reported receiving National Institutes of Health research funding for the study of a manual CPR device.
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
FLUOXETINE (PROZAC) IS NOT EFFECTIVE IN HELPING RECOVERING ANOREXIA
PATIENTS MAINTAIN WEIGHT
VIDEO:
B-ROLL
Carole walking outside into building through revolving door - video runs
over "My life was terrible" in bite
AUDIO:
THIRTY-EIGHT-YEAR-OLD CAROLE STOCKER HAS SUFFERED FROM ANOREXIA FOR MORE THAN A DECADE. AT ONE POINT SHE WEIGHED LESS THAN EIGHTY POUNDS.
VIDEO:
SOT/FULL
@ :09
Super: Carole Stocker
Suffers from anorexia
Runs :07
AUDIO:
"My life was terrible. It's been ten years in and out of hospitals, in
and out of treatment centers."
VIDEO:
B-ROLL
Carole walking in hall
Fluoxetine pills pouring from bottle to pharmacy tray
AUDIO:
WHILE HOSPITALIZED SHE WAS ABLE TO REACH A HEALTHY WEIGHT. THE
CHALLENGE IS KEEPING THAT WEIGHT ON WHEN PATIENTS LEAVE THE HOSPITAL.
DOCTORS THOUGHT FLUOXETINE, ORIGINALLY MARKETED AS PROZAC, MIGHT HELP.
VIDEO:
SOT/FULL
@ :25
Super: Timothy Walsh, M.D.
Columbia University
Runs :12
AUDIO:
"We were trying to determine whether a widely used anti-depressant,
fluoxetine, would be helpful in keeping people who've made an initial
recovery from anorexia nervosa, to keep them well for a long period of
time."
VIDEO:
B-ROLL
Dr. Walsh and colleague discussing data at computer
Cutaway graph on computer screen
Cutaway colleague
AUDIO:
DR. TIMOTHY WALSH AND HIS COLLEAGUES AT COLUMBIA UNIVERSITY, AND AT
UNIVERSITY OF TORONTO, STUDIED NINETY-THREE WOMEN WHO'D BEEN
HOSPITALIZED WITH SEVERE ANOREXIA. AFTER THE WOMEN REACHED HEALTHY
WEIGHTS, THEY WERE DISCHARGED FROM THE HOSPITAL.
VIDEO:
SOT/FULL
Timothy Walsh, M.D.
Columbia University
Runs :16
AUDIO:
"Everybody who got discharged got some good psychological treatment and
half of them also got fluoxetine and half of them got placebo and we
followed them for a year and watched to see and hoped that they would
stay well."
VIDEO:
B-ROLL
GFX/JAMA COVER
Backtime Dr. Walsh from "surprised"
AUDIO:
THE STUDY APPEARS IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION. THE RESULTS SURPRISED AND DISAPPOINTED DR. WALSH.
VIDEO:
SOT/FULL
Timothy Walsh, M.D.
Columbia University
Runs :09
AUDIO:
"What we found, unfortunately, was there was absolutely no difference
between the fluoxetine-treated group and the placebo-treated group."
VIDEO:
B-ROLL
Pharmacist pouring/counting fluoxetine pills
AUDIO:
THE RATE OF RELAPSE, OF LOSING WEIGHT AGAIN, WAS ESSENTIALLY THE SAME IN
BOTH GROUPS. CAROLE WASN'T PART OF THE STUDY, BUT SHE DID TRY
FLUOXETINE AND IT DIDN'T HELP HER.
VIDEO:
SOT/FULL
Carole Stocker
Suffers from anorexia
Runs :07
AUDIO:
"I think they were hoping for a magic pill, but, not too surprised that
it didn't work."
VIDEO:
B-ROLL
Carole sitting, talking with Dr. Walsh in his office
AUDIO:
WHAT DID HELP HER WAS GOOD THERAPY, WHICH IS WHAT DR. WALSH RECOMMENDS
FOR ALL ANOREXIA PATIENTS. CAROLE NOW WEIGHS ONE-HUNDRED-FIFTEEN
POUNDS, AND IS HOPEFUL ABOUT HER FUTURE. THIS IS MAVIS PRALL WITH THE
JAMA REPORT.
