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 20, 2007)
JAMA NEWS RELEASES
ATHEROSCLEROTIC DISEASE ASSOCIATED WITH HIGH RATES OF CARDIOVASCULAR EVENTS WITHIN ONE YEAR
RATE OF SECONDARY CANCERS INCREASES OVER YEARS AFTER TREATMENT FOR CHILDHOOD LEUKEMIA
BLACK-WHITE LIFE EXPECTANCY GAP NARROWS, BUT REMAINS SUBSTANTIAL
DISCLOSURE LAWS PROVIDE ONLY LIMITED VIEW OF PHARMACEUTICAL COMPANY PAYMENTS TO PHYSICIANS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
LIFE EXPECTANCY GAP BETWEEN AMERICAN BLACKS AND WHITES SLOWLY DECREASING
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TV Note: This week's JAMA Report video is on the trend in the life expectancy gap between blacks and whites in the U.S. The report will be fed Tuesday, March 20, 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 20, 2007
Media Advisory: To contact Ph. Gabriel Steg, M.D., email: gabriel.steg{at}bch.aphp.fr. To contact co-author Deepak L. Bhatt, M.D., call Natalie Guzzo at 216-444-5703. To contact editorialist Mary McGrae McDermott, M.D., call Marla Paul at 312-503-8928.
ATHEROSCLEROTIC DISEASE ASSOCIATED WITH HIGH RATES OF CARDIOVASCULAR EVENTS WITHIN ONE YEAR
CHICAGO—Patients with atherosclerotic arterial disease have relatively high rates of experiencing a cardiovascular event (such as heart attack, stroke or cardiovascular death) within one year, according to a large, international study in the March 21 issue of JAMA.
Atherothrombosis (atherosclerotic arterial disease, such as coronary artery disease [CAD], cerebrovascular disease [CVD], and peripheral arterial disease [PAD; narrowing of the arteries that supply the legs and feet]) is associated with the main causes of death on a worldwide scale, according to background information in the article. "Recent U.S. data have confirmed that, despite a decrease in age-standardized national death rates, the absolute number of deaths from these conditions continues to increase, and prevalence is sharply increasing in other parts of the world. Thus, atherothrombotic diseases are, and are projected still to be, the leading cause of death worldwide by 2020." Few studies have documented the current cardiovascular (CV) event rates in patients with atherothrombosis.
Ph. Gabriel Steg, M.D., of the Hôpital Bichat-Claude Bernard, Paris, and colleagues examined the characteristics and CV event rates of patients for whom 1-year follow-up data were available from the Reduction of Atherothrombosis for Continued Health (REACH) Registry, an international group of 68,236 patients with either established atherosclerotic arterial disease (such as CAD, PAD, CVD; n = 55,814) or at least three risk factors for atherothrombosis (n = 12,422). The participants were enrolled from 5,587 physician practices in 44 countries in 2003-2004.
As of July 2006, 1-year outcomes were available for 95 percent (n = 64,977) of participants. The researchers found that in the overall stable population with established arterial disease, approximately 1 in 7 patients had a cardiovascular event (CV death, heart attack, and stroke) or was hospitalized for a CV event or revascularization procedure within a year of enrollment. Patients with established arterial disease experienced 2 to 3 times higher event rates than patients with multiple risk factors only.
The overall combined CV death, heart attack, or stroke rate at 1 year was 4.24 percent, ranging from 2.15 percent of patients with multiple risk factors only to 6.47 percent of patients enrolled with CVD and 4.69 percent for those with established atherosclerotic arterial disease.
Among patients with established disease, CV death, heart attack, or stroke rates were 4.52 percent for patients with CAD and 5.35 percent for patients with PAD. The incidences of CV death, heart attack, or stroke or of hospitalization for atherothrombotic event(s) were 15.20 percent for CAD, 14.53 percent for CVD, and 21.14 percent for PAD patients with established disease. These event rates increased with the number of symptomatic arterial disease locations.
"The high event rates observed in this large, stable, contemporary outpatient cohort of patients with established atherosclerotic arterial disease or with multiple atherothrombotic risk factors indicate that continued efforts are needed to improve secondary prevention and clinical outcomes. Initiatives to improve adherence to evidence-based guidelines and care are an important tool in this respect. In addition, the strong association of asymptomatic and symptomatic multiple locations of atherothrombosis with event rates suggests that atherothrombosis should be addressed as a global arterial disease in patients," the authors conclude.
(JAMA. 2007;297:1197-1206. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo) who assisted with the design and conduct of the study and data collection. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: THE INTERNATIONAL PANDEMIC OF CHRONIC CARDIOVASCULAR DISEASE
In an accompanying editorial, Mary McGrae McDermott, M.D., of Northwestern University Feinberg School of Medicine, Chicago, comments on the findings of Steg and colleagues.
"The REACH Registry demonstrates that the cardiovascular disease epidemic remains a critical and urgent international public health problem. Despite recent substantial scientific progress in the understanding of cardiovascular disease pathophysiology and optimal therapies for cardiovascular disease, major challenges remain to prevent cardiovascular events and disability in patients with established cardiovascular disease. Public health infrastructures and health care systems must be developed to facilitate global implementation of optimal therapies for cardiovascular disease and reverse the increasing prevalence of obesity, physical inactivity, and their associated complications."
(JAMA. 2007;297:1253-1254. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. McDermott reports that she has received honoraria from Bristol-Myers Squibb, Sanofi-Aventis, NicOx, and Otsuka Pharmaceutical, has served as a consultant for Hutchinson Technology, and is currently receiving support from research grants from the National Heart, Lung, and Blood 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: 3:00 p.m. CT, Tuesday, March 20, 2007
Media Advisory: To contact Nobuko Hijiya, M.D., call Betty Chiu at 901-578-2334.
RATE OF SECONDARY CANCERS INCREASES OVER YEARS AFTER TREATMENT FOR CHILDHOOD LEUKEMIA
CHICAGO—Survivors of acute lymphoblastic leukemia have a significantly increased risk of secondary cancers developing over 30 years after leukemia treatment when compared to the general population, according to a study in the March 21 issue of JAMA.
Acute lymphoblastic leukemia is the most common cancer in children and adolescents, with almost 4,000 new cases diagnosed in the United States each year. It is also one of the most curable pediatric cancers: survival rates for patients who receive contemporary treatments now exceed 80 percent, and most of these survivors are cured (no evidence of disease for at least 10 years). "Accordingly, characterization of long-term outcomes in acute lymphoblastic leukemia patients who remain in first complete remission for at least a decade has assumed increasing importance, especially in view of the long life expectancy of this survivor population." But little is known about the incidence of secondary tumors or cancer after 15 to 20 years in children and adolescents who were treated for acute lymphoblastic leukemia.
Nobuko Hijiya, M.D., of St. Jude Children’s Research Hospital, Memphis, Tenn., and colleagues conducted a study to estimate the long-term (30-year) cumulative incidence of secondary neoplasms (cancers) in 2,169 children and adolescents treated for acute lymphoblastic leukemia between 1962 and 1998 at St. Jude Children’s Research Hospital. The patients had achieved complete remission and had a median (mid-point) follow-up time of 18.7 years (range, 2.4 - 41.3 years).
The researchers found that among the 1,290 patients who remained in complete remission, 123 (9.5 percent) developed a secondary neoplasm as their first event. The cumulative incidence of secondary neoplasms in all patients as the first event after complete remission was 4.17 percent at 15 years, increasing to 5.37 percent at 20 years and to 10.85 percent at 30 years. "The relatively rapid increase in incidence at 20 years after complete remission can be attributed largely to the late development of meningiomas [a tumor near the brain and spinal cord] and basal cell carcinomas," the authors write.
When meningiomas and basal cell carcinomas were excluded, the overall cumulative incidence was 3.99 percent at 15 years and 6.27 percent at 30 years, representing a 13.5-fold increase in overall risk compared with the general population.
The cumulative incidence of each tumor type at 30 years was 2.19 percent for myeloid (related to bone marrow) malignancy, 0.17 percent for lymphoma, 3.00 percent for brain tumor, 4.91 percent for carcinoma, and 0.57 percent for sarcoma.
"In conclusion, the cumulative incidence of secondary neoplasm after treatment for childhood acute lymphoblastic leukemia does not attain a plateau at 15 to 20 years but continues to increase over 30 years. Although the majority of these late-occurring secondary neoplasms are low-grade tumors such as meningioma and basal cell carcinoma, the health care issues they raise may be critical. The risk for high-grade tumors, especially carcinomas, significantly exceeds the risk in the general population, underscoring the need for continued careful follow-up of acute lymphoblastic leukemia survivors," the authors write.
(JAMA. 2007;297:1207-1215. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported in part by grants from the National Institutes of Health and by the American Lebanese Syrian Associated Charities. Co-author Ching-Hon Pui, M.D., is an American Cancer Society professor. 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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For Immediate Release
Media Advisory: To contact Sam Harper, Ph.D., call Lisa Van Dusen at 514-398-6752.
BLACK-WHITE LIFE EXPECTANCY GAP NARROWS, BUT REMAINS SUBSTANTIAL
CHICAGO—Reductions in the death rate from homicide, HIV disease, unintentional injuries – and among women, heart disease – have contributed to narrowing the life expectancy gap between blacks and whites in the United States, although substantial inequalities and challenges remain, according to a study in the March 21 issue of JAMA.
Life expectancy at birth has generally been increasing in the United States since at least the late 19th century. For as long as data have been reported by race/ethnicity, life expectancy of blacks has been lower than that of whites, according to background information in the article. Since the early 1980s, the black-white life expectancy gap increased sharply, then subsequently declined. But the causes of these changes have not been investigated.
Sam Harper, Ph.D., of McGill University, Montreal, Quebec, and colleagues conducted a study to determine the contribution of specific age groups and causes of death to changes in the black-white life expectancy gap from 1983 to 2003. They analyzed data from the U.S. National Vital Statistics System, maintained by the National Center for Health Statistics, which collects information on all deaths occurring in the United States each year.
The authors report that after widening during the late 1980s, the black-white life expectance gap has declined because of relative mortality improvements in homicide, HIV disease, unintentional injuries – and among women, heart disease.
"For females, heart disease made by far the largest contribution to the overall life expectance gap, accounting for 1.4 years (28 percent) of the gap in 1983, 1.6 years (28 percent) in 1993, and 1.3 years (30 percent) in 2003," the authors write. "Other important causes of the 4.5-year gap in 2003 include diabetes (0.5 years), stroke (0.4 years), and perinatal death (0.4 years)."
"Among males, the largest contribution to the gap was homicide in 1983 (1.1 years) and 1993 (1.6 years), but by 2003 heart disease became the leading cause, accounting for 1.4 years (21 percent) of the overall 6.3-year gap, followed by homicide (one year), HIV (0.6 years), and perinatal death (0.4 years)," they continue.
The current difference in life expectancy at birth between blacks and whites remains substantial, 6.3 years for men and 4.5 years for women. "Homicide, HIV, and perinatal death, although demonstrating favorable trends, continue to keep the black-white gap unnecessarily large, and unfavorable mortality trends in nephritis [kidney disease] and septicemia [bloodstream infection] are currently contributing to widening the gap," the authors write.
The authors emphasize that further narrowing of the gap will require concerted efforts to address the major causes of the remaining gap.
"Reducing social and individual risk factors for major causes of death and improving access and quality of care for blacks, particularly for cardiovascular diseases, should be a pressing priority for public health and health care," they conclude.
(JAMA. 2007;297:1224-1232. Available to the media at www.jamamedia.org)
Editor's Note: This work was supported in part by the Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research Program (co-authors John Lynch, Ph.D., George Davey Smith, M.D., and Scott Burris, J.D.) and by a contract from the National Cancer Institute (Dr. Harper). 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 20, 2007
Media Advisory: To contact Joseph S. Ross, M.D., M.H.S., call Lucia Lee at 212-241-9200. To contact editorial co-author Troyen A. Brennan, M.D., M.P.H., call Jill Griffiths at 860-273-8162.
DISCLOSURE LAWS PROVIDE ONLY LIMITED VIEW OF PHARMACEUTICAL COMPANY PAYMENTS TO PHYSICIANS
CHICAGO—Laws in two states requiring disclosure of pharmaceutical company payments to physicians do not provide the public with easy access to payment information and are of limited quality when accessed, according to a study in the March 21 issue of JAMA.
Interactions between the pharmaceutical industry and health care professionals often involve payments, including cash, gift certificates, meals, textbooks or conference fees. In contrast to many other professions, medicine allows payments from a company to an individual who decides whether and how often to use products produced by the company. "To avoid undue influence, the American Medical Association recommends that gifts (but not other payments) to physicians should benefit patients and should not exceed $100 in value, a recommendation similar to those of other medical organizations and the Pharmaceutical Research and Manufacturers of America," according to background information in the article.
Recent legislation in five states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies. In two of these states, Vermont and Minnesota, payment disclosures are publicly available.
Joseph S. Ross, M.D., M.H.S., of Mount Sinai School of Medicine, New York, and colleagues analyzed publicly available data in Vermont (from July 2002 through June 2004) and Minnesota (from January 2002 through December 2004).
The authors found that the laws enacted by Vermont and Minnesota fail to provide the public with easy access to information about payments from pharmaceutical companies to physicians and other health care professionals.
"In Vermont, 61 percent of payments were not released to the public because pharmaceutical companies designated them as trade secrets and 75 percent of publicly disclosed payments were missing information necessary to identify the recipient," the authors write. "In Minnesota, 25 percent of companies reported in each of the three years."
The study also found that pharmaceutical companies made substantial numbers of payments of $100 or more to physicians.
"In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2,416 payments of $100 or more to physicians," the authors write. "In Minnesota, among 6,946 payments totaling $30.96 million publicly disclosed, there were 6,238 payments of $100 or more to physicians."
The authors believe that the information obtained through disclosure laws is insufficient for revealing the true pattern of payments.
"Making these payments publicly available will require more stringent laws with clear mechanisms for enforcement," they conclude.
(JAMA. JAMA.2007;297:1216-1223. Available 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: SUNSHINE LAWS AND THE PHARMACEUTICAL INDUSTRY
In an accompanying editorial, Troyen A. Brennan, M.D., M.P.H., of Aetna Inc., Hartford, Conn., and Michelle M. Mello, M.Phil., Ph.D., J.D., of the Harvard School of Public Health, Boston, write that the findings of Ross and colleagues are discouraging.
"First, numerous payments to physicians exceeded the $100 limit that has been suggested by the American Medical Association," they write. "Second, and worse, there are many holes in the reporting."
"To be clear, for-profit industries do not share the same ethical norms to which physicians and other health care professionals must adhere. Their primary commitment is to create shareholder value, not maintain an altruistic commitment to patients," they write. "But at some point the leadership of the pharmaceutical industry and their boards of directors must begin to recognize that growing public and professional mistrust could substantially detract from that value."
(JAMA. 2007;297:1255-1256. Available 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
LIFE EXPECTANCY GAP BETWEEN AMERICAN BLACKS AND WHITES
SLOWLY DECREASING
INTRO:
African Americans do not live as long as white Americans. But a new study gives some specific reasons why the gap between black and white life expectancy may be slowly closing. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
SOT/FULL
@ :02
Super: Sam Harper, Ph.D.
McGill University
Runs :09
AUDIO:
“We compiled a database of every death among blacks and whites that occurred in the United States from the years 1983 to 2003, roughly 46 million deaths.”
VIDEO:
B-ROLL
Dr. Harper and colleague at computer looking at data
AUDIO:
THAT’S HOW DR. SAM HARPER OF MCGILL UNIVERSITY IN MONTREAL AND HIS COLLEAGUES FIGURED OUT THAT:
VIDEO:
SOT/FULL
Sam Harper, Ph.D.
McGill University
Runs :05
AUDIO:
“Blacks are living longer and catching up to whites in terms of life expectancy.”
VIDEO:
GFX/JAMA COVER
B-ROLL
Black man crossing street with white man and woman
FULL SCREEN GRAPHIC over video image
Title: Life expectancy gap
Between black and white men = 8.5 years in 1993
6.5 years in 2003
Between black and white women = 5.5 years in 1993
4.5 years in 2003
AUDIO:
IN A STUDY PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, DR. HARPER FOUND THAT THE LIFE EXPECTANCY GAP BETWEEN BLACK AND WHITE MEN IMPROVED FROM ABOUT EIGHT-AND-A-HALF YEARS IN 1993 TO ABOUT SIX-AND-A-HALF YEARS IN 2003. THE GAP FOR WOMEN WENT FROM ABOUT FIVE-AND-A-HALF YEARS TO ABOUT FOUR-AND-A HALF YEARS.
VIDEO:
SOT/FULL
Sam Harper, Ph.D.
McGill University
Runs :13
AUDIO:
“We found that reductions in deaths from homicide, HIV and unintentional injuries were a major reason why we saw these declines in both men and women. Also among women we found that reductions in heart disease also made a strong contribution to the decline.”
VIDEO:
B-ROLL
Black teens no faces showing
AUDIO:
THE BIGGEST IMPROVEMENT WAS IN BLACK MALES AGES FIFTEEN TO FORTY-NINE LIVING LONGER.
VIDEO:
SOT/FULL
Sam Harper, Ph.D.
McGill University
Runs :15
AUDIO:
“This can be related to improvements in violence around crack cocaine markets, increases in the sizes of police forces and improvements in the economy. These things may have had a beneficial effect in terms of young black males living longer.”
VIDEO:
B-ROLL
Variety of shots of Black people walking on city sidewalk
Pan from nurse to black man with electrodes on his chest
Close-up of black infant
Pull out to show mom
Dr. Cox-Batson (she is black) walking down hall with another black female patient
AUDIO:
DR. HARPER SAYS FURTHER IMPROVEMENTS OBVIOUSLY NEED TO BE MADE, PARTICULARLY IN REDUCING HOMICIDE, HIV AND CARDIOVASCULAR DISEASE IN AFRICAN AMERICANS. REDUCING INFANT MORTALITY IS ALSO IMPORTANT, WHICH IS NO SURPRISE TO CHICAGO OBSTETRICIAN STEPHANIE COX-BATSON.
VIDEO:
SOT/FULL
@ :1:28
Super: Stephanie Cox-Batson, M.A.,M.D.
Obstetrician
Runs :12
AUDIO:
“Unfortunately we continue to see a large number of women coming in very late for prenatal care and when they present later in care it’s very hard for us to really affect the outcome of that pregnancy.”
VIDEO:
B-ROLL
Dr. Cox-Batson examining black patient
AUDIO:
BUT SHE’S PLEASED TO HEAR THAT OVERALL, THE GAP BETWEEN BLACK AND WHITE LIFE EXPECTANCY IS CLOSING.
VIDEO:
SOT/FULL
Stephanie Cox-Batson, M.A.,M.D.
Obstetrician
Runs :08
AUDIO:
“Of course, I would hope that the disparity continues to narrow, on a personal level, you know, as well as for my patients.”
VIDEO:
B-ROLL
Dr. Cox-Batson listening to baby’s heartbeat
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
In studying unintentional injuries, Dr. Harper found a potential reason for the closing of the gap. Not only did he see fewer deaths from unintentional injuries among blacks, but he also saw increases in unintentional injuries among whites. He says those increases may be related to a rise in drug-related deaths among whites. For more information, visit www.jama.com.
