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, July 3, 2007)
JAMA NEWS RELEASES
CONSUMPTION OF SMALL AMOUNTS OF DARK CHOCOLATE ASSOCIATED WITH REDUCTION IN BLOOD PRESSURE
INCREASE IN PRESCRIPTION DRUG COST SHARING ASSOCIATED WITH LOWER RATES OF DRUG TREATMENT, ADHERENCE
STUDY EXAMINES CAUSE OF HEARING LOSS FOR PATIENTS WITH CERTAIN GENETIC DISEASE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
EATING DAILY SMALL AMOUNTS OF DARK CHOCOLATE MAY HELP LOWER BLOOD PRESSURE
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TV Note: This week's JAMA Report video is on the association between consumption of dark chocolate and reduction in blood pressure. The report will be fed Tuesday, July 3, 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 3, 2007
Media Advisory: To contact Dirk Taubert, M.D., Ph.D., email: dirk.taubert{at}medizin.uni-koeln.de.
CONSUMPTION OF SMALL AMOUNTS OF DARK CHOCOLATE ASSOCIATED WITH REDUCTION IN BLOOD PRESSURE
CHICAGO—Eating about 30 calories a day of dark chocolate was associated with a lowering of blood pressure, without weight gain or other adverse effects, according to a study in the July 4 issue of JAMA.
Previous research has indicated that consumption of high amounts of cocoa-containing foods can lower blood pressure (BP), believed to be due to the action of the cocoa polyphenols (a group of chemical substances found in plants, some of which, such as the flavanols, are believed to be beneficial to health). “A particular concern is that the potential BP reduction contributed by the flavanols could be offset by the high sugar, fat and calorie intake with the cocoa products,” the authors write. The effect of low cocoa intake on BP is unclear.
Dirk Taubert, M.D., Ph.D., of University Hospital of Cologne, Germany, and colleagues assessed the effects of low regular amounts of cocoa on BP. The trial, conducted between January 2005 and December 2006, included 44 adults (age 56 through 73 years; 24 women, 20 men) with untreated upper-range prehypertension (BP 130/85 – 139/89) or stage 1 hypertension (BP 140/90 – 160/100). Participants were randomly assigned to receive for 18 weeks either 6.3 g (30 calories) per day of dark chocolate containing 30 mg polyphenols or matching polyphenol-free white chocolate.
The researchers found that from baseline to 18 weeks, dark chocolate intake reduced average systolic BP by −2.9 (1.6) mm Hg and diastolic BP by −1.9 (1.0) mm Hg without changes in body weight, plasma levels of lipids or glucose. Hypertension prevalence declined from 86 percent to 68 percent. Systolic and diastolic BP remained unchanged throughout the treatment period among those in the white chocolate group. Dark chocolate consumption resulted in the short-term appearance of cocoa phenols in plasma and increased vasodilatory S-nitrosoglutathione. There was no change in plasma biomarkers in the white chocolate group.
“Although the magnitude of the BP reduction was small, the effects are clinically noteworthy. On a population basis, it has been estimated that a 3-mm Hg reduction in systolic BP would reduce the relative risk of stroke mortality by 8 percent, of coronary artery disease mortality by 5 percent, and of all-cause mortality by 4 percent,” the authors write.
“The most intriguing finding of this study is that small amounts of commercial cocoa confectionary convey a similar BP-lowering potential compared with comprehensive dietary modifications that have proven efficacy to reduce cardiovascular event rate. Whereas long-term adherence to complex behavioral changes is often low and requires continuous counseling, adoption of small amounts of flavanol-rich cocoa into the habitual diet is a dietary modification that is easy to adhere to and therefore may be a promising behavioral approach to lower blood pressure in individuals with above-optimal blood pressure. Future studies should evaluate the effects of dark chocolate in other populations and evaluate long-term outcomes,” the authors conclude.
(JAMA. 2007;298(1):49-60. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 3, 2007
Media Advisory: To contact Dana P. Goldman, Ph.D., call Warren Robak at 310-451-6913.
INCREASE IN PRESCRIPTION DRUG COST SHARING ASSOCIATED WITH LOWER RATES OF DRUG TREATMENT, ADHERENCE
CHICAGO—A review of previous studies indicates that an increase in prescription drug cost sharing is associated with a decrease in drug spending and use of pharmacies; and for some chronic conditions, higher cost sharing is associated with greater use of expensive medical services, according to an article in the July 4 issue of JAMA.
“...with recent increases in pharmacy spending, pharmacy benefit managers and health plans have adopted benefit changes designed to reduce pharmaceutical use or steer patients to less-expensive alternatives. The rapid proliferation of mail-order pharmacies, mandatory generic substitution, coinsurance plans, and multitiered formularies has transformed the benefit landscape,” the authors write.
Dana P. Goldman, Ph.D., of RAND, Santa Monica, Calif., and colleagues analyzed previous studies to determine how cost-sharing features of prescription drug benefits may affect access to prescription drugs and how these features may affect medical spending and health outcomes. For this analysis, the researchers identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance, pharmacy benefit caps or monthly prescription limits, formulary restrictions, and reference pricing, and outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.
“Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10 percent increase in cost sharing, prescription drug spending decreases by 2 percent to 6 percent, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features,” the researchers write.
“For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.”
“These findings make benefit design an important public health tool for improving population health. The challenge for public and private plans is to make patients more sensitive to the cost of treatment without encouraging them to forego cost-effective care. This requires knowing how patients respond to different incentives and cataloging the net benefits of alternative therapies, not only for health, but also for current and future health care costs, productivity, and patient utility,” the authors conclude.
(JAMA. 2007;298(1):61-69. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 3, 2007
Media Advisory: To contact John A. Butman, M.D., Ph.D., call Shana Potash at 301-594-5788.
STUDY EXAMINES CAUSE OF HEARING LOSS FOR PATIENTS WITH CERTAIN GENETIC DISEASE
CHICAGO—Patients with the genetic disorder von Hippel-Lindau disease may suddenly experience hearing loss because of a tumor-associated hemorrhage in the inner ear, according to a study in the July 4 issue of JAMA.
Endolymphatic sac tumors (ELSTs; tumors of the inner ear) occur sporadically but may be associated with von Hippel-Lindau disease (VHL; a genetic disease characterized by the development of blood vessel tumors in the retina of the eye and in the brain; lesions and cysts can also develop in other parts of the body). ELSTs are associated with significant dysfunction of hearing and balance, including sudden irreversible hearing loss. The mechanisms and appropriate treatments for this disorder are not well understood.
John A. Butman, M.D., Ph.D., of the National Institutes Health, Bethesda, Md., and colleagues conducted a study, between May 1990 and December 2006, to determine the mechanisms underlying hearing loss in patients with ELSTs. Clinical findings and audiologic data were correlated with magnetic resonance imaging and computed tomography imaging studies. Thirty-five patients with von Hippel-Lindau disease and ELSTs in 38 ears were identified.
“...the most common ELST–associated clinical finding in this series was hearing loss. Sensorineural hearing loss (SNHL) occurred in 31 patients (89 percent) or 34 of the affected ears (89 percent) and was frequently moderate or profound. Other less frequent ELST–associated findings included aural [pertaining to the ear or hearing] fullness, aural pain, facial nerve weakness, and aural pain and facial nerve weakness combined,” the authors write.
Intralabyrinthine (inner ear) hemorrhage was found in 11 of 14 ears with sudden SNHL but occurred in none of the 17 ears with gradual SNHL or normal hearing. Tumor size was not related to SNHL.
“Based on the relationship between the imaging and clinical findings in these patients, 3 distinct mechanisms (either alone or in combination) may account for the audiovestibular [hearing and balance] morbidity associated with ELSTs. These include direct invasion of the otic capsule [embryonic cartilage capsule that surrounds the inner ear mechanism and develops into bony tissue] by tumor, intralabyrinthine hemorrhage, and endolymphatic hydrops [recurrent vertigo accompanied by ringing in the ears and deafness].”
“Since significant audiovestibular dysfunction, including deafness, can occur suddenly in a manner that is not related to tumor size, early surgical intervention may be warranted. While this study does not address the effectiveness of surgical resection, several small operative series indicate that complete resection of ELSTs can be curative, can alleviate vestibular symptomatology, and can be performed with hearing preservation and minimal morbidity.”
“Therefore, in patients with hearing and imaging evidence of an ELST, surgery may be considered after weighing its potential risks to prevent neurologic worsening or amelioration of symptoms. To intervene early, prompt diagnosis based on clinical and imaging findings is necessary. Thus, serial clinical evaluations and high-resolution MRI and CT imaging to detect small ELSTs or intralabyrinthine hemorrhage are warranted in patients with VHL,” the authors conclude.
(JAMA. 2007;298(1):41-48. 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
EATING DAILY SMALL AMOUNTS OF DARK CHOCOLATE MAY HELP LOWER BLOOD PRESSURE
INTRO:
If you’re worried about high blood pressure, you may want to add dark chocolate to your Independence Day diet. A new study suggests that eating daily, small amounts of dark chocolate can help lower some people’s blood pressure. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Pan from river to museum
AUDIO:
IN COLOGNE GERMANY, A CHOCOLATE MUSEUM ATTRACTS CHOCOLATE LOVERS FROM FAR AND WIDE.
VIDEO:
NAT SOT UP FOR FOR :03
German woman
AUDIO:
“I love it. It’s smooth and it tastes great.”
VIDEO:
NAT SOT UP FOR FOR :03
German man
AUDIO:
“I like it. The taste is fantastic, so that’s the reason.”
VIDEO:
NAT SOT UP FOR FOR :05
American man
AUDIO:
“I eat chocolate maybe two times a week.”
VIDEO:
B-ROLL
Backtime below nat sot
AUDIO:
BUT THERE MAY BE A BETTER REASON THAN TASTE TO EAT DARK CHOCOLATE MORE OFTEN.
VIDEO:
NAT SOT UP FOR FOR :02
Two American women eating dark chocolate
AUDIO:
“Mmm, that’s lovely.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Pieces of dark chocolate in clear plastic dish – researcher picks up dish
C/u blood pressure reading
AUDIO:
ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, EATING A DAILY PIECE OF DARK CHOCOLATE, THE SIZE OF THESE PIECES... ABOUT A QUARTER OF AN OUNCE...COULD HELP TO LOWER YOUR SYSTOLIC BLOOD PRESSURE, THE UPPER NUMBER, BY ALMOST THREE UNITS, AND THE DIASTOLIC BLOOD PRESSURE, OR BOTTOM NUMBER BY ALMOST TWO UNITS.
VIDEO:
SOT/FULL
@ :42
Super: Dirk Taubert, M.D., Ph.D.
University Hospital of Cologne
Runs :08
AUDIO:
“We were indeed surprised that such a low amount of chocolate could efficiently reduce the blood pressure.”
VIDEO:
B-ROLL
Dr. Taubert and colleagues in lab looking at computer and pieces of chocolate
Extreme close up of dark chocolate
White chocolate pieces in dish
Extreme close up of mouth eating dark chocolate
AUDIO:
DR. DIRK TAUBERT (TAU-bert) AND COLLEAGUES AT UNIVERSITY HOSPITAL OF COLOGNE, STUDIED FORTY-FOUR OTHERWISE HEALTHY PEOPLE WITH HIGH BLOOD PRESSURE FOR EIGHTEEN WEEKS. HALF THE PEOPLE GOT DAILY DARK CHOCOLATE, HALF GOT DAILY WHITE CHOCOLATE. NO ONE GAINED WEIGHT, BUT ONLY THE DARK-CHOCOLATE EATERS SAW THEIR BLOOD PRESSURE COME DOWN A BIT.
VIDEO:
SOT/FULL
Dirk Taubert, M.D., Ph.D.
University Hospital of Cologne
Runs : 09
AUDIO:
“Our study provides sufficient evidence to recommend low amounts of polyphenol-rich dark chocolate as an addition to a healthy diet.”
VIDEO:
B-ROLL
Cocoa beans
Dark chocolate in wrap that says “99% cocoa”
AUDIO:
POLYPHENOLS (POL-ee-FEN-ols) ARE CHEMICALS FOUND IN PLANTS, INCLUDING COCOA. ONE WAY TO TELL IF YOU’RE EATING POLYPHENOLS IS BY THE BITTER TASTE.
VIDEO:
“There’s a simple rule. The bitter (stet) the chocolate tastes, the more polyphenols chocolate will contain.”
B-ROLL
Jens having blood pressure taken
AUDIO:
JENS (yens) CHEMNITZ (KEM-nitz) HAS HIGH BLOOD PRESSURE.
VIDEO:
SOT/FULL
@ 1:33
Super: Jens Chemnitz
Has high blood pressure
Runs : 04
AUDIO:
“I would try this piece of chocolate a day, definitely.”
VIDEO:
B-ROLL
Different mouth eating dark chocolate
AUDIO:
HE’S NOT ALONE.
VIDEO:
NAT SOT UP FOR FOR :03
Same American man
AUDIO:
“Maybe I need to eat more dark chocolate.”
VIDEO:
B-ROLL
Researcher wrapping dark chocolate in foil
AUDIO:
BUT BE SURE TO TALK WITH YOUR DOCTOR ABOUT THE BEST WAY FOR YOU TO IMPROVE YOUR BLOOD PRESSURE LEVELS. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Taubert says polyphenols in dark chocolate seem to increase the production of a substance in the body called nitric oxide, which causes the blood vessels to widen, making more room for the blood to flow and lowering blood pressure. He stresses that people with high blood pressure should not replace their blood pressure medications with chocolate. For more information, visit www.jama.com.
