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 5, 2007)
JAMA NEWS RELEASES
FOLIC ACID SUPPLEMENTS DO NOT APPEAR TO REDUCE RISK OF COLORECTAL TUMORS
PERFORMANCE-RELATED FINANCIAL INCENTIVES FOR HOSPITALS NOT ASSOCIATED WITH IMPROVED QUALITY OF CARE OR OUTCOMES FOR HEART ATTACK PATIENTS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
FOLIC ACID SUPPLEMENTATION DOES NOT REDUCE RISK OF COLON POLYPS – IT MAY EVEN INCREASE THE RISK
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on whether folic acid supplements help to prevent colorectal tumors. The report will be fed Tuesday, June 5, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 09, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
SAVE THE DATE: JAMA will present new research from its theme issue on Chronic Diseases of Children at a media briefing on Tuesday, June 26, from 10 a.m. – 12:15 p.m., at the Millennium Broadway Hotel in New York. Program and registration information will be included in a future email.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 5, 2007
Media Advisory: To contact Bernard F. Cole, Ph.D., call Hali Wickner at 603-650-1520. To contact the editorial authors, Cornelia M. Ulrich, M.S., Ph.D., or John D. Potter, M.D., Ph.D., call Kristen Woodward at 206-667-5095.
FOLIC ACID SUPPLEMENTS DO NOT APPEAR TO REDUCE RISK OF COLORECTAL TUMORS
CHICAGO—New research indicates that folic acid supplementation does not decrease the risk of benign colorectal tumors, but may possibly increase the risk for some type of colorectal tumors, according to a study in the June 6 issue of JAMA. Previous studies have suggested that folate supplementation may help to prevent colorectal tumors.
Bernard F. Cole, Ph.D., of Dartmouth Medical School, Hanover, N.H., and colleagues evaluated the effect of folate for the prevention of new colorectal adenomas (benign tumors, precursors of most colorectal cancers) in persons with a history of these types of lesions. The trial was conducted at nine clinical centers between July 1994 and October 2004 and included 1,021 men and women with a recent history of colorectal adenomas but no previous large intestine cancerous tumor. Participants were randomly assigned to receive 1 mg/day of folic acid (n = 516) or placebo (n = 505), and were separately randomized to receive aspirin (81 or 325 mg/day) or placebo. Follow-up consisted of two colonoscopic examination cycles (the first interval was at 3 years and the second at 3 or 5 years later).
In the first follow-up interval, adenomas occurred in 42.4 percent of the participants in the placebo group and 44.1 percent of the participants in the folic acid group. In the second follow-up interval, adenomas occurred in 37.2 percent of the participants in the placebo group and 41.9 percent of the participants in the folic acid group.
In both follow-up intervals, participants in the folic acid group tended to have higher rates of advanced adenomas and multiple adenomas. In the first follow-up interval, advanced lesions occurred in 8.6 percent of the participants in the placebo group and 11.4 percent of the participants in the folic acid group. The respective numbers in the second follow-up interval were 6.9 percent and 11.6 percent for both groups, a 67 percent (but non-statistically significant) increased risk of advanced lesions. Participants in the folic acid group (30 individuals, 9.9 percent) had more than twice the risk of having three or more adenomas than those in the placebo group (13 individuals, 4.3 percent).
“In conclusion, our study indicates that folate, when administered as folic acid for up to 6 years, does not decrease the risk of adenoma formation in the large intestine among individuals with previously removed adenomas. The evidence for an increased risk of adenomas is equivocal and requires further research. In view of the fortification of the U.S. food supply with folate, and some suggestions that folate could conceivably increase the risk of neoplasia even outside the colorectum, this line of investigation should have a high priority,” the authors write.
(JAMA. 2007;297:2351-2359. 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: FOLATE AND CANCER—TIMING IS EVERYTHING
In an accompanying editorial, Cornelia M. Ulrich, M.S., Ph.D., and John D. Potter, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, discuss the findings of Cole and colleagues.
“How should the unexpected results of this study be interpreted? The most likely explanation for the increased risk of advanced and multiple adenomas in the intervention group is that undetected early precursor lesions were present in the mucosa [a type of membrane] of these patients (who are at increased adenoma risk), and that folic acid promoted growth of these lesions. This hypothesis is consistent with experimental studies showing increased colorectal neoplasia when folic acid is administered after lesions are present.”
“Nonetheless, by the nature of the design, the results do not provide information on primary prevention by folic acid (the potential for folic acid to reduce the incidence of first adenomas). The question of efficacy of folate in cancer prevention is not resolved, and animal experiments showing chemopreventive effects of folate, as well as the strong observational epidemiological evidence, speak to the potential of folate as a chemopreventive agent, if taken early. Unfortunately, primary prevention trials that start in childhood would be lengthy, expensive, and logistically nearly impossible.”
“The results of the clinical trial by Cole et al illustrate, yet again, the principle that chemoprevention with single agents is problematic. Similar to the increased risk of lung cancer observed with beta carotene supplementation, selection of resistant clones is as plausible an outcome of the use of single-agent chemoprevention as it is of single-agent chemotherapy,” they write. “It is time to be as thoughtful about the need for multiagent chemoprevention, not forgetting that diet is one version of this, as about the use of multiagent chemotherapy.”
(JAMA. 2007;297:2408-2409. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article 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, June 5, 2007
Media Advisory: To contact corresponding author Eric D. Peterson, M.D., M.P.H., call Tracey Koepke at 919-660-1301.
PERFORMANCE-RELATED FINANCIAL INCENTIVES FOR HOSPITALS NOT ASSOCIATED WITH IMPROVED QUALITY OF CARE OR OUTCOMES FOR HEART ATTACK PATIENTS
CHICAGO—A pay-for-performance program at hospitals was not associated with significant improvement in processes of care or outcomes for heart attack patients, according to a study in the June 6 issue of JAMA.
“The concept of providing financial incentives to health care givers to improve quality of care, known as pay for performance, has received national attention as a potential means of narrowing well-documented gaps between health care guidelines and clinical practice,” the authors write. In 2003, the Centers for Medicare & Medicaid Services (CMS) launched the largest pay-for-performance pilot project to date in the United States, including indicators for acute myocardial infarction (heart attack). Participating hospitals with the highest performance measures would receive a reimbursement bonus, while those with the poorest performance risked future financial penalty.
Seth W. Glickman, M.D., M.B.A., of Duke University Medical Center, Durham, N.C., and colleagues examined whether hospitals participating in the pay-for-performance program showed improvement in certain process measures and outcomes for treatment of heart attack beyond that in hospitals not participating in the quality-improvement program. The study included an analysis of data for 105,383 patients with acute non–ST-segment elevation myocardial infarction (a certain pattern on an electrocardiogram following a heart attack). Patients were treated between July 2003 and June 2006 at 54 hospitals in the CMS program and 446 control hospitals.
The researchers found that composite measure scores for CMS processes showed significant improvement at both pay-for-performance and control hospitals. There was no significant difference in the rate of improvement in the composite score between the two hospital groups. Two of the six CMS measures, aspirin prescription at discharge and smoking cessation counseling, had slightly higher rates of improvement at pay-for-performance hospitals than control hospitals. For composite measures of heart attack treatments not subject to incentives, rates of improvement were not significantly different. There was a slight reduction in the rate of deaths over time at both pay-for-performance and control hospitals, although the difference in the rate of the reductions between the groups was not statistically significant.
“In conclusion, this study is one of the first to evaluate the CMS pay-for-performance pilot project. Among hospitals participating in a voluntary quality-improvement registry, pay-for-performance had limited incremental impact on processes of care and outcomes for acute myocardial infarction. Conversely, we did not find evidence that pay-for-performance had an adverse impact on improvement in processes of care that were not subject to financial incentives. Additional studies of pay-for-performance are needed to determine its optimal role in quality-improvement initiatives,” the researchers write.
(JAMA. 2007;297:2373-2380. 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.
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
FOLIC ACID SUPPLEMENTATION DOES NOT REDUCE RISK OF COLON POLYPS – IT MAY EVEN INCREASE THE RISK
INTRO:
Colon polyps can sometimes turn into cancer. Some studies have hinted that taking large amounts of a vitamin called folic acid could help prevent colon polyps. But a new study says taking high-dose folic acid supplements does not reduce the risk of colon polyps, and may even increase the risk. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
NAT SOT UP FULL FOR :03
Dr. Robertson performing “mock” colonoscopy on “patient”
AUDIO:
“Getting a nice look at the colon here, it looks very healthy."
VIDEO:
B-ROLL
C/u Dr. Roberston (wearing mask)
Different angle of patient, doctor and video screen
AUDIO:
DR. DOUG ROBERTSON IS A GASTROENTEROLOGIST AT A V-A HOSPITAL IN VERMONT. HE’S DEMONSTRATING A COLONOSCOPY, LOOKING FOR POLYPS.
VIDEO:
SOT/FULL
@ :13
Super: Doug Robertson, M.D.
Gastroenterologist
Runs :05
AUDIO:
“We deal with patients who have polyps really every day of my working life.”
VIDEO:
B-ROLL
Still image of polyp in colon (provided by Dr. Robertson)
Dr. Robertson demonstrating colonoscopy
C/u folic acid supplements – Brands blurred
AUDIO:
DOCTORS CAN REMOVE COLON POLYPS PRETTY EASILY, WHICH IS IMPORTANT BECAUSE POLYPS CAN SOMETIMES TURN INTO CANCER. RESEARCHERS THOUGHT THAT TAKING HIGH DOSES OF FOLIC ACID MIGHT PREVENT POLYPS FROM GROWING, BUT....
VIDEO:
SOT/FULL
@: 23
Super: John Baron, M.D.
Dartmouth Medical School
Runs : 08
AUDIO:
“We found that folic acid did not decrease the risk of colon polyps. In fact, in some analyses we saw suggestions that folic acid might increase risk of those polyps.”
VIDEO:
B-ROLL
Dr. Baron and colleagues consulting over data
GFX/JAMA COVER
AUDIO:
DR. JOHN BARON AND COLLEAGUES AT DARTMOUTH MEDICAL SCHOOL WERE PART OF A NATIONWIDE STUDY OF ABOUT A THOUSAND PEOPLE WHO HAD HAD POLYPS. FOR AT LEAST THREE YEARS, HALF TOOK ONE MILLIGRAM OF FOLIC ACID SUPPLEMENT DAILY, AND HALF TOOK PLACEBO, TO SEE IF THE FOLIC ACID COULD PREVENT NEW POLYPS. IT DIDN’T, AND THE FINDINGS, PUBLISHED IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, ALSO INCLUDE THIS:
VIDEO:
SOT/FULL
John Baron, M.D.
Dartmouth Medical School
Runs : 10
AUDIO:
“We also saw an increase in the risk of prostate cancer in the folate group. This is a surprising finding, it’s far from definitive, but it’s something that should be looked into in the future.”
VIDEO:
B-ROLL
Wide shot of cereal isle in grocery store
C/u ingredient list showing folic acid – highlighted “folic acid”
Very wide shot of bread isle
AUDIO:
SO SHOULD WE WORRY ABOUT THE FOLIC ACID THAT’S IN SO MANY DIFFERENT FOODS? AFTER ALL, FOLIC ACID DOES HAVE HEALTH BENEFITS. DR. BARON SAYS WE DON’T HAVE TO AVOID FOODS THAT CONTAIN FOLIC ACID...
VIDEO:
SOT/FULL
John Baron, M.D.
Dartmouth Medical School
Runs : 04
AUDIO:
“But that seeking out folic acid in large amounts may not be a good idea until this issue is resolved.”
VIDEO:
B-ROLL
Dr. Robertson demonstrating colonoscopy
AUDIO:
DR. ROBERTSON, WHO WAS ALSO A RESEARCHER ON THIS STUDY, SAYS THE BEST ADVICE HE CAN GIVE IS TO SEEK OUT SCREENING FOR POLYPS.
VIDEO:
SOT/FULL
Doug Robertson, M.D.
Gastroenterologist
Runs :08
AUDIO:
“There are multiple ways that people can go about getting screened. Colonoscopy is certainly the most effective way to identify colon polyps and colon cancer.”
VIDEO:
B-ROLL
Dr. Robertson demonstrating colonoscopy and/or image of polyp
AUDIO:
AND IDENTIFYING THOSE CAN BE LIFE SAVING. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
It's important to remember that folic acid does have health benefits, particularly for women who may get pregnant, because it can reduce the risk of some birth defects in babies. The people in the study took one milligram of folic acid a day. That daily dose is more than twice as much folic acid as doctors usually recommend for women of reproductive age. Dr. Baron says there is no reason to change that recommendation, because the benefits of folic acid in this case are clear. For more information, visit www.jama.com.
