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, March 6, 2007)
JAMA NEWS RELEASES
COMPUTED TOMOGRAPHY SCREENING MAY INCREASE RATE OF LUNG CANCER DIAGNOSIS, BUT NOT DECREASE RISK OF DEATH
COMPARISON OF 4 DIET PLANS SHOWS BETTER OUTCOMES FOR DIET WITH LOWEST CARBOHYDRATE INTAKE
OPENING OF SPECIALTY CARDIAC HOSPITALS ASSOCIATED WITH INCREASE IN RATE OF CARDIAC PROCEDURES
BOTH MINOR AND MAJOR ELECTROCARDIOGRAM ABNORMALITIES ASSOCIATED WITH INCREASED RISK OF DEATH AND CARDIOVASCULAR EVENTS IN WOMEN
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
LOW-CARBOHYDRATE DIET MOST EFFECTIVE IN DIET COMPARISON STUDY, AND DID NOT INCREASE BLOOD PRESSURE OR CHOLESTEROL
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
This week's JAMA Report video is on the comparison of four diet plans. The report will be fed Tuesday, March 6, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (C-Band), Transponder 09, Downlink Frequency 3880 MHz Vertical, Audio: 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, March 6, 2007
Media Advisory: To contact Peter B. Bach, M.D., M.A.P.P., call Joanne Nicholas at 212-639-3573. To contact editorial co-author William C. Black, M.D., call Jason Aldous at 603-653-1913.
COMPUTED TOMOGRAPHY SCREENING MAY INCREASE RATE OF LUNG CANCER DIAGNOSIS, BUT NOT DECREASE RISK OF DEATH
CHICAGO—Screening current or former smokers with the imaging technique of computed tomography may increase the rate of diagnosis and treatment of lung cancer, but may not necessarily reduce the risk of advanced lung cancer or death from lung cancer, according to a study in the March 7 issue of JAMA.
Lung cancer accounts for 25 percent of cancer deaths and 6 percent of all deaths in the United States. Screening with chest x-rays is not effective in reducing the risk of advanced lung cancer or death, according to background information in the article. There is hope that lung cancer screening with computed tomography (CT) will be more effective at reducing deaths from lung cancer because it is more sensitive for the detection of very small nodules.
Peter B. Bach, M.D., M.A.P.P., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues examined the effect of CT screening on individuals by comparing the frequency of lung cancer detection, resection (surgical removal of part of the lung), advanced lung cancer cases, and deaths from lung cancer with what would have occurred in the absence of screening (using a prediction model). The study (a combination of three studies) included 3,246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at one of two academic medical centers in the United States or an academic medical center in Italy with follow-up for a median (midpoint) of 3.9 years. Participants received annual CT scans with comprehensive evaluation and treatment of detected nodules.
The researchers found that individuals screened with CT were three times more likely to be diagnosed with lung cancer (144 diagnosed cases vs. 44.5 expected cases), and 10 times more likely to undergo a lung cancer surgery (109 individuals with lung surgery vs. 10.9 expected cases). Computed tomography screening did not appear to reduce the risk of advanced lung cancer diagnoses or deaths due to lung cancer.
“Our finding of a 10-fold increase in lung cancer surgeries resulting from screening underscores one of the potential public health consequences of CT screening. If the majority of excess early cancers found through screening are unlikely to progress rapidly to a point where they cause clinically significant disease or death, then the thoracic surgeries performed to remove them may be insufficiently beneficial to justify the resulting morbidities,” the authors write.
“Our findings that CT screening is not associated with a reduction in the chance that a person will develop advanced lung cancer or die from lung cancer are important negative results that should influence how screening is viewed up until that time when more rigorous data are available from randomized trials.”
“These findings, because they are thematically consistent with the findings of several randomized studies of lung cancer screening with chest X-ray, should raise doubts about the premise underpinning CT screening for lung cancer, and also raise concerns about its potential harms if pursued on a wide scale,” the researchers write.
(JAMA. 2007;297:953-961. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: CT SCREENING FOR LUNG CANCER — SPIRALING INTO CONFUSION
In an accompanying editorial, William C. Black, M.D., of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; and John A. Baron, M.D., of Dartmouth Medical School, Hanover, N.H., comment on the study in this week’s JAMA on CT screening for lung cancer, in which the results differed significantly from the results of a recent similar study.
“As Bach et al acknowledge, formulation of screening policy should await the rigorous assessment that will be provided by ongoing randomized controlled trials (the National Lung Screening Trial [in the U.S.] and the NELSON Trial [in Europe]). Randomized controlled trials are the most reliable method for obtaining accurate assessments of the benefits and harms of screening in the underlying population. With this design, differences in outcome can be attributed to the intervention without reliance on highly modeled analyses with problematic assumptions. Although expensive and time-consuming, rigorous trials of cancer screening are far more cost-effective than what might be the alternative—widespread adoption of costly screening interventions that cause more harm than good.”
(JAMA. 2007;297:995-997. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the editorial for additional information, including financial disclosures, funding and support, etc.
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, March 6, 2007
Media Advisory: To contact Christopher D. Gardner, Ph.D., call Susan Ipaktchian at 650-725-5375.
COMPARISON OF 4 DIET PLANS SHOWS BETTER OUTCOMES FOR DIET WITH LOWEST CARBOHYDRATE INTAKE
CHICAGO—Premenopausal women who were assigned to follow the Atkins diet for one year lost more weight when compared to women who were assigned to follow the Zone, Ornish and LEARN diets, according to a study in the March 7 issue of JAMA.
Overweight and obesity are well-documented problems in the United States. National dietary weight loss guidelines (a diet low in calories and fat, high in carbohydrates) have been challenged, particularly by supporters of low-carbohydrate diets. However, limited evidence has been available to effectively evaluate other diets, according to background information in the article.
Christopher D. Gardner, Ph.D., of Stanford University Medical School, Stanford, Calif., and colleagues examined the effects of four diets—3 popular and substantially different diets and 1 diet based on national guidelines—representing a spectrum of carbohydrate intake, on weight loss and related metabolic variables in overweight and obese premenopausal women. The diets were Atkins (very low in carbohydrate), Zone (low in carbohydrate), LEARN (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition; low in fat, high in carbohydrate, based on national guidelines), and Ornish (high in carbohydrate). The study, which included 311 overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women, was conducted from February 2003 to October 2005. Participants were randomly assigned to follow for 12 months the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.
Besides weight loss, the participants were also measured for lipid profile (low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12.
The researchers found that weight loss was greater for women in the Atkins diet group compared with the other diet groups at one year. Average 12-month weight loss was 10.4 lbs for Atkins, 3.5 lbs. for Zone, 5.7 lbs. for LEARN, and 4.8 lbs. for Ornish. At 12 months, measurements for lipids and levels of insulin, glucose and blood pressure for the Atkins group were comparable with or more favorable than the other diet groups.
“Concerns about adverse metabolic effects of the Atkins diet were not substantiated within the 12-month study period. It could not be determined whether the benefits were attributable specifically to the low carbohydrate intake vs. other aspects of the diet (e.g., high protein intake). While questions remain about long-term effects and mechanisms, these findings have important implications for clinical practice and health care policy. Physicians whose patients initiate a low-carbohydrate diet can be reassured that weight loss is likely to be at least as large as for any other dietary pattern and that the lipid effects are unlikely to be of immediate concern. As with any diet, physicians should caution patients that long-term success requires permanent alterations in energy intake and energy expenditure, regardless of macronutrient content,” the authors conclude.
(JAMA. 2007;297:969-977. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This investigation was supported by grants from the National Institutes of Health, the Community Foundation of Southeastern Michigan, and by a grant from the Human Health Service, General Clinical Research Centers, National Center for Research Resources, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, March 6, 2007
Media Advisory: To contact Brahmajee K. Nallamothu, M.D., M.P.H., call Bonnie Johnson at 734-761-7910. To contact editorial co-author Peter Cram, M.D., M.B.A., call Becky Soglin at 319-335-6660.
OPENING OF SPECIALTY CARDIAC HOSPITALS ASSOCIATED WITH INCREASE IN RATE OF CARDIAC PROCEDURES
CHICAGO—The opening of a specialty cardiac hospital is associated with an increase in the rate of coronary revascularization in a region, compared to new cardiac programs opened at general hospitals, according to a study in the March 7 issue of JAMA.
Specialty hospitals, which provide care limited to specific medical conditions or procedures, are opening at a rapid pace across the United States, according to background information in the article. Proponents argue that specialty hospitals provide higher quality health care and greater cost-efficiency by concentrating physician skills and hospital resources needed for managing complex diseases. Critics claim that specialty hospitals focus primarily on low-risk patients and provide less uncompensated care, which places competing general hospitals at significant financial risk.
“However, specialty hospitals raise an additional concern beyond their potential to simply redistribute cases within a health care market. Specialty hospitals are typically smaller than general hospitals and have high rates of physician ownership. Physician owners may have stronger financial incentives for providing services that fuel greater utilization,” the authors write.
Brahmajee K. Nallamothu, M.D., M.P.H., of the VA Health Services Research and Development Center of Excellence, Ann Arbor, Mich., and colleagues conducted a study to determine whether the opening of specialty cardiac hospitals was associated with greater utilization of coronary revascularization services. The researchers calculated annual population-based rates for total revascularization (coronary artery bypass graft [CABG] plus percutaneous coronary intervention [PCI]), CABG, and PCI of Medicare beneficiaries from 1995 through 2003. Hospital referral regions (HRRs) were used to categorize health care markets into those where (1) cardiac hospitals opened (n = 13), (2) new cardiac programs opened at general hospitals (n = 142), and (3) no new programs opened (n = 151).
The researchers found that overall, rates of change for total revascularization were higher in HRRs after cardiac hospitals opened when compared with HRRs where new cardiac programs opened at general hospitals and HRRs with no new programs. “Four years after their opening, the relative increase in adjusted rates was more than 2-fold higher in HRRs where cardiac hospitals opened (19.2 percent) when compared with HRRs where new cardiac programs opened at general hospitals (6.5 percent) and HRRs with no new programs (7.4 percent).”
“Although we are unable to comment directly on the appropriateness of these procedures, these findings raise the concern that the opening of cardiac hospitals may lead to greater procedural utilization beyond the simple addition of capacity to a market. This is particularly worrisome since cardiac hospitals may not substantially improve clinical outcomes when compared with general hospitals with similar procedural volumes,” the researchers write.
“...our findings may have important policy implications. The Centers for Medicare & Medicaid Services recently issued their final report to Congress implementing a strategic plan for specialty hospitals. Their plan primarily involves revisions to the inpatient prospective payment systems to ‘level the playing field’ between specialty and general hospitals and limit financial incentives for investing in certain services simply due to profitability. It also proposes new ‘gainsharing’ and value-based payment approaches to better align physician and hospital incentives toward improving care at general hospitals. Reforms directly related to physician ownership include enhanced transparency of financial relationships. More stringent measures, such as limiting investments by physician owners, were not included. The extent to which additional measures are needed will require further data on appropriateness of care at specialty hospitals as well as the impact of greater utilization of these procedures on patient outcomes.”
(JAMA. 2007;297:962-968. Available to the media at www.jamamedia.org)
Editor's Note: This project was supported by a grant from the Agency for Healthcare Research and Quality. Dr. Nallamothu completed part of this work while supported as a clinical scholar under a K12 grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PHYSICIAN-OWNED SPECIALTY HOSPITALS AND CORONARY REVASCULARIZATION UTILIZATION — TOO MUCH OF A GOOD THING?
In an accompanying editorial, Peter Cram, M.D., M.B.A., and Gary E. Rosenthal, M.D., of the University of Iowa Carver College of Medicine, Iowa City, Iowa examine the findings of Nallamothu and colleagues.
“The emergence of specialty hospitals is in an early state of evolution but may represent the beginning of a fundamental reorganization in the ways in which hospitals are structured and care is delivered. Specialization already permeates most sectors of the U.S. economy and is associated with both increased efficiency and product quality. Although there is no fundamental reason hospital care should differ, the current findings suggest that physician ownership of specialty hospitals may be problematic if such ownership increases the use of services for patients with marginal indications. As specialty hospitals evolve, vigilance will be needed to determine if benefits are being delivered as promised and if untoward effects on the delivery system are emerging. In the meantime, all hospitals will need to look carefully at specialty hospitals to see what, if any, lessons can be gleaned from their successes and failures.”
(JAMA. 2007;297:998-999. Available to the media at www.jamamedia.org)
Editor's Note: Dr. Cram is the recipient of a K23 career development award from the National Center for Research Resources, National Institutes of Health. This research was also supported by a grant from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs. Financial disclosures – none reported.
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, March 6, 2007
Media Advisory: To contact Pablo Denes, M.D., call Marla Paul at 312-503-8928.
BOTH MINOR AND MAJOR ELECTROCARDIOGRAM ABNORMALITIES ASSOCIATED WITH INCREASED RISK OF DEATH AND CARDIOVASCULAR EVENTS IN WOMEN
CHICAGO—Postmenopausal women without symptoms of cardiovascular problems who have minor or major abnormalities on an electrocardiogram are at increased risk for future cardiovascular events and death, according to a study in the March 7 issue of JAMA.
Resting 12-lead electrocardiogram (ECG) abnormalities are independently associated with incident coronary heart disease (CHD) and cardiovascular disease (CVD) events. Many prior studies included only men or compared men and women but the women were not selected for age or the presence or absence of underlying heart disease, according to background information in the article. Data are sparse regarding the prevalence, incidence, and independent prognostic value of minor and/or major electrocardiographic abnormalities in asymptomatic postmenopausal women. There is no information on the effect, if any, of hormonal treatment on the prognostic value of the ECG.
Pablo Denes, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues conducted a study to examine the association of baseline and new ECG findings with CHD and CVD outcomes in the placebo and hormonal treatment groups of the Women’s Health Initiative (WHI) estrogen plus progestin trial. This portion of the trial, which was stopped in July 2002, examined whether in healthy postmenopausal women this combination would reduce CHD and CVD events. The trial found that there was a significant increase in CHD rates among women taking hormone therapy compared with the placebo group.
The sample analyzed included 14,749 postmenopausal asymptomatic women with intact uterus who received 1 daily tablet containing 0.625 mg of oral conjugated equine estrogen and 2.5 mg of medroxyprogesterone acetate or a matching placebo. Participants were enrolled from 1993 to 1998.
The researchers found that among women with absent (n = 9,744), minor (n = 4,095), and major (n = 910) ECG abnormalities, there were 118, 91, and 37 incident CHD events, respectively. The incident annual CHD event rates per 10,000 women with absent, minor, or major ECG abnormalities were 21, 40, and 75, respectively. After 3 years of follow-up, 5 percent of women who had normal ECG at baseline developed new ECG abnormalities with an annual CHD event rate of 85 per 10,000 women. There were no significant interactions between hormone treatment assignment and ECG abnormalities for risk prediction of cardiovascular end points.
“In a large cohort of postmenopausal, asymptomatic women who were without a history of prior CVD and participating in the estrogen plus progestin group of the WHI trial, we found that minor and major baseline ECG abnormalities were associated with significantly increased risks for CHD and CVD events, independent of established risk factors and hormone treatment,” the authors write.
“Given the low cost, wide availability, and ease of interpretation, the ECG may be a useful tool for assisting in the prediction of future cardiovascular events in asymptomatic postmenopausal women. The presence of ECG abnormalities should prompt physicians to consider further risk stratification, more intensive therapeutic interventions, or both on modifiable risk factors for primary prevention of cardiovascular events.”
(JAMA. 2007;297:978-985. Available to the media at www.jamamedia.org)
Editor's Note: The Women’s Health Initiative program was funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, U.S. Department of Health and Human Services. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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
LOW-CARBOHYDRATE DIET MOST EFFECTIVE IN DIET COMPARISON STUDY, AND DID NOT INCREASE BLOOD PRESSURE OR CHOLESTEROL
INTRO:
The Atkins diet is a very popular way to lose weight. But cutting carbs and eating more protein and fat worries some doctors, who fear it could lead to increased cholesterol and blood pressure. Now a new study comparing Atkins to three other diets shows that not only was Atkins the most successful at weight loss, it did NOT increase blood pressure or cholesterol. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Christine talking with doctor
Atkins food (tuna kabobs) being prepared
AUDIO:
CHRISTINE DILLON WAS PART OF A STUDY COMPARING THE ATKINS, LOW-CARBOHYDRATE DIET WITH THREE OTHER, HIGHER CARB DIETS.
VIDEO:
SOT/FULL
@ :08
Super: Christine Dillon
Lost weight on Atkins diet
Runs :10
AUDIO:
“I was on the Atkins diet for about 9 months and lost between 10 and 15 pounds but much more importantly lost two dress sizes, which is huge.”
VIDEO:
B-ROLL
Christine’s bite up until “which”
GFX/JAMA Cover
FULL SCREEN GRAPHIC
Title: Diet comparison study
Atkins
Zone
LEARN
Ornish
AUDIO:
THOSE RESULTS WERE PRETTY TYPICAL FOR ATKINS DIETERS IN THE STUDY, WHICH IS PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. IT COMPARED THE ATKINS, ZONE, LEARN AND ORNISH DIETS IN ABOUT THREE-HUNDRED YOUNG AND MIDDLE-AGED WOMEN.
VIDEO:
SOT/FULL
@ :32
Super: Christopher Gardner, Ph.D.
Stanford University
Runs :10
AUDIO:
“By the end of the year, on average within the Atkins group, the average woman lost 10 pounds compared to the other three groups where the average loss was closer to 5 pounds.”
VIDEO:
B-ROLL
Dr. Gardner with colleague
AUDIO:
DR. CHRISTOPHER GARDNER OF STANFORD UNIVERSITY WAS A RESEARCHER ON THE STUDY, WHICH LOOKED AT MORE THAN JUST WEIGHT LOSS.
VIDEO:
SOT/FULL
Christopher Gardner, Ph.D.
Stanford University
Runs :12
B-ROLL
“One of the concerns that health professionals have had about these very low carbohydrate diets is that possibly the high fat content would be bad for people in terms of their cholesterol levels or their blood pressure.”
AUDIO:
B-ROLL
Dr. Stafford taking Christine’s blood pressure
VIDEO:
BUT IN THIS STUDY, BLOOD PRESSURE AND CHOLESTEROL STAYED HEALTHY IN WOMEN ON ATKINS. DR. GARDNER SAYS THE SIMPLICITY OF THE DIET MAY BE THE KEY TO ITS SUCCESS.
AUDIO:
SOT/FULL
Christopher Gardner, Ph.D.
Stanford University
Runs :08
VIDEO:
“Cutting out those simple refined carbohydrates, the white bread, the white rice, the high fructose corn syrup, the soda pop.”
AUDIO:
B-ROLL
Young woman drinking bottled water (no brand showing)
Dr. Stafford with Christine in exam room
Overweight women walking outside
VIDEO:
IN FACT, PEOPLE ON ATKINS REPLACED SODA POP WITH DRINKING LOTS OF WATER, AND DR. GARDNER THINKS THAT PLAYED A BIG ROLE IN HEALTHY WEIGHT LOSS. STUDY CO-AUTHOR DR. RANDALL STAFFORD AGREES. HE SPECIALIZES IN PREVENTING HEART DISEASE, AND SAYS THIS DIET COULD HELP, BECAUSE HEALTHY WEIGHT REDUCES HEART DISEASE RISK.
AUDIO:
SOT/FULL
@ 1:33
Super: Randall Stafford, M.D., Ph.D.
Stanford University
Runs :13
VIDEO:
“This study will change my practices. In the future I’m going to be more supportive of patients who come in already on an Atkins diet, and I’m certainly going to suggest this as a possible, reasonable approach to weight loss.”
AUDIO:
B-ROLL
Woman eating Atkins food
VIDEO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The study authors stress that if people are going to go on the Atkins diet, they should follow the actual diet, which includes all kinds of healthy proteins, not just those that are high in fat and cholesterol. For more information, visit www.jama.com.
