Current Table of Contents

• CLINICAL CROSSROADS: An 82-Year-Old Woman With Hypertension and Renal Artery Stenosis
  
• THIS WEEK IN JAMA: This Week in JAMA
  
• ORIGINAL CONTRIBUTION: Variants of the Adiponectin (ADIPOQ) and Adiponectin Receptor 1 (ADIPOR1) Genes and Colorectal Cancer Risk
  

  Context  Current epidemiological evidence suggests an association between obesity, hyperinsulinemia, and colorectal cancer risk. Adiponectin is a hormone secreted by the adipose tissue, and serum levels are inversely correlated with obesity and hyperinsulinemia. While there is evidence of an association between circulating adiponectin levels and colorectal cancer risk, no association between genes of the adiponectin pathway and colorectal cancer have been reported to date.

  Objective  To determine the association of 10 haplotype-tagging single-nucleotide polymorphisms (SNPs) of the adiponectin (ADIPOQ) and adiponectin receptor 1 (ADIPOR1) genes with colorectal cancer risk.

  Design, Setting, and Patients  Two case-control studies including patients with a diagnosis of colorectal cancer and controls were recruited between 2000 and 2007. Case-control study 1 included a total of 441 patients with a diagnosis of colorectal cancer and 658 controls; both groups were of Ashkenazi Jewish ancestry and from New York, New York. Case-control study 2 included 199 patients with a diagnosis of colorectal cancer and 199 controls from Chicago, Illinois, matched 1:1 for sex, age, and ethnicity.

  Main Outcome Measures  ADIPOQ and ADIPOR1 SNP frequency among cases and controls.

  Results  In study 1, after adjustment for age, sex, and SNPs from the same gene, 3 ADIPOQ SNPs and 1 ADIPOR1 SNP were associated with colorectal cancer risk: rs266729 (adjusted odds ratio [AOR], 0.72; 95% confidence interval [CI], 0.55-0.95) and rs822396 (AOR, 0.37; 95% CI, 0.14-1.00) were associated with decreased risk whereas rs822395 (AOR, 1.76; 95% CI, 1.09-2.84) and rs1342387 (AOR, 1.79; 95% CI, 1.18-2.72) were associated with increased risk. In study 2, after adjustment for age, sex, race, and SNPs from the same gene, the ADIPOQ SNP rs266729 was associated with a decreased colorectal cancer risk of similar magnitude as in study 1 (AOR, 0.52; 95% CI, 0.34-0.78). Combined analysis of both studies shows an association of rs266729 with decreased colorectal cancer risk (AOR, 0.73; 95% CI, 0.53-0.99).

  Conclusion  The SNP rs266729, which tags the 5' flanking region of the ADIPOQ gene, is associated with decreased colorectal cancer risk.

• ORIGINAL CONTRIBUTION: Effects of a Reduced Dose Schedule and Intramuscular Administration of Anthrax Vaccine Adsorbed on Immunogenicity and Safety at 7 Months: A Randomized Trial
  

  Context  In 1999, the US Congress directed the Centers for Disease Control and Prevention to conduct a pivotal safety and efficacy study of anthrax vaccine adsorbed (AVA).

  Objective  To determine the effects on serological responses and injection site adverse events (AEs) resulting from changing the route of administration of AVA from subcutaneous (SQ) to intramuscular (IM) and omitting the week 2 dose from the licensed schedule.

  Design, Setting, and Participants  Assessment of the first 1005 enrollees in a multisite, randomized, double-blind, noninferiority, phase 4 human clinical trial (ongoing from May 2002).

  Intervention  Healthy adults received AVA by the SQ (reference group) or IM route at 0, 2, and 4 weeks and 6 months (4-SQ or 4-IM; n = 165-170 per group) or at a reduced 3-dose schedule (3-IM; n = 501). A control group (n = 169) received saline injections at the same time intervals.

  Main Outcome Measures  Noninferiority at week 8 and month 7 of anti–protective antigen IgG geometric mean concentration (GMC), geometric mean titer (GMT), and proportion of responders with a 4-fold rise in titer (%4xR). Reactogenicity outcomes were proportions of injection site and systemic AEs.

  Results  At week 8, the 4-IM group (GMC, 90.8 µg/mL; GMT, 1114.8; %4xR, 97.7) was noninferior to the 4-SQ group (GMC, 105.1 µg/mL; GMT, 1315.4; %4xR, 98.8) for all 3 primary end points. The 3-IM group was noninferior for only the %4xR (GMC, 52.2 µg/mL; GMT, 650.6; %4xR, 94.4). At month 7, all groups were noninferior to the licensed regimen for all end points. Solicited injection site AEs assessed during examinations occurred at lower proportions in the 4-IM group compared with 4-SQ. The odds ratio for ordinal end point pain reported immediately after injection was reduced by 50% for the 4-IM vs 4-SQ groups (P < .001). Route of administration did not significantly influence the occurrence of systemic AEs.

  Conclusions  The 4-IM and 3-IM regimens of AVA provided noninferior immunological priming by month 7 when compared with the 4-SQ licensed regimen. Intramuscular administration significantly reduced the occurrence of injection site AEs.

  Trial Registration  clinicaltrials.gov Identifier: NCT00119067

• ORIGINAL CONTRIBUTION: News Media Coverage of Medication Research: Reporting Pharmaceutical Company Funding and Use of Generic Medication Names
  

  Context  The news media are an important source of information about medical research for patients and even some physicians. Little is known about how frequently news articles report when medication research has received funding from pharmaceutical companies or how frequently news articles use generic vs brand medication names.

  Objectives  To assess the reporting of pharmaceutical company funding and generic medication name use in news articles about medication studies and to determine the views of newspaper editors about these issues.

  Design, Setting, and Participants  We reviewed US news articles from newspaper and online sources about all pharmaceutical company–funded medication studies published in the 5 most prominent general medical journals between April 1, 2004, and April 30, 2008. We also surveyed editors at the 100 most widely circulated newspapers in the United States.

  Main Outcome Measures  The percentage of news articles indicating when studies have been pharmaceutical company–funded and the percentage that refer to medications by their generic vs brand names. Also the percentage of newspaper editors who indicate that their articles report pharmaceutical company funding; the percentage of editors who indicate that their articles refer to medications by generic names; and the percentage of newspapers with policies about these issues.

  Results  Of the 306 news articles about medication research identified,130 (42%; 95% confidence interval [CI], 37%-48%) did not report that the research had received company funding. Of the 277 of these articles reporting on medications with both generic and brand names, 186 (67%; 95% CI, 61%-73%) referred to the study medications by their brand names in at least half of the medication references. Eighty-two of the 93 (88%) newspaper editors who responded to our survey reported that articles from their publications always or often indicated when studies had received company funding (95% CI, 80%-94%), and 71 of 92 (77%) responding editors also reported that articles from their publications always or often referred to medications by the generic names (95% CI, 67%-85%). However, only 3 of 92 newspapers (3%) had written policies stating that company funding sources of medical studies be reported (95% CI 1%-9%), and 2 of 93 (2%) newspapers had written policies stating that medications should be referred to by their generic names (95% CI 1%-8%).

  Conclusion  News articles reporting on medication studies often fail to report pharmaceutical company funding and frequently refer to medications by their brand names despite newspaper editors' contention that this is not the case.

• REVIEW: Effectiveness of Long-term Psychodynamic Psychotherapy: A Meta-analysis
  

  Context  The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking.

  Objective  To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis.

  Data Sources  Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsycINFO, and Current Contents, supplemented by contact with experts in the field.

  Study Selection  Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies).

  Data Extraction  Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment.

  Results  According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of 1.8 (95% confidence interval [CI], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P = .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98).

  Conclusions  There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.

• CLINICAL CROSSROADS: A 60-Year-Old Woman With Mild Memory Impairment: Review of Mild Cognitive Impairment
  

  Many older individuals experience or demonstrate cognitive impairment that is significantly abnormal for their age and education yet beneath the threshold for a diagnosis of dementia. This mild cognitive impairment causes minimal functional impairment and is often overlooked in clinical settings, yet affected individuals are at heightened risk for a range of adverse outcomes including conversion to dementia. The case of Ms E, a 60-year-old woman with mild memory impairment and white matter lesions on magnetic resonance imaging, provides an opportunity to consider the questions that face patient, family, and clinicians when mild cognitive symptoms prompt a search for diagnosis and management options. Discussion of her case reviews mild cognitive impairment with emphasis on an evidence-based approach to evaluation and treatment, including management of comorbid medical conditions, lifestyle changes, and pharmacotherapy.

• COMMENTARY: The Right to Bear Arms: Constitutional Law, Politics, and Public Health
  
• COMMENTARY: Nosocomial Infection, the Deficit Reduction Act, and Incentives for Hospitals
  
• COMMENTARY: The Conflict Between Complex Systems and Reductionism
  
• JAMA CLASSICS: Closed-Chest Cardiac Massage: Progress Measured by the Exceptions
  
• EDITORIAL: Update on JAMA's Policy on Release of Information to the Public
  
• EDITORIAL: Psychodynamic Psychotherapy and Research Evidence: Bambi Survives Godzilla?
  
• LETTERS: Ultrasound and Mammography for Breast Cancer Screening
  
• LETTERS: Ultrasound and Mammography for Breast Cancer Screening
  
• LETTERS: Ultrasound and Mammography for Breast Cancer Screening--Reply
  
• LETTERS: Nonmammographic Screening for Breast Cancer
  
• LETTERS: Nonmammographic Screening for Breast Cancer--Reply
  
• LETTERS: Request for Complementary Medicine After Brain Death
  
• LETTERS: Request for Complementary Medicine After Brain Death
  
• LETTERS: Request for Complementary Medicine After Brain Death--Reply
  
• RESEARCH LETTERS: Driving Fatalities on US Presidential Election Days
  
• MEDICAL NEWS & PERSPECTIVES: Risks and Benefits of Direct-to-Consumer Genetic Testing Remain Unclear
  
• MEDICAL NEWS & PERSPECTIVES: Emergency Departments See High Rates of Adverse Events From Antibiotic Use
  
• MEDICAL NEWS & PERSPECTIVES: Cerumen Removal Guidelines Wax Practical
  
• LAB, FIELD, & CLINIC: Researchers Devise Innovative Method to Overcome Cancer-Related Drug Resistance
  
• LAB REPORTS: Clues to Preeclampsia
  
• LAB REPORTS: Eye Disease Gene
  
• LAB REPORTS: Stem Cell Lines
  
• LAB REPORTS: Good Fat
  
• FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION: Commercial Fishing Fatalities--California, Oregon, and Washington, 2000-2006
  
• FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION: Nonpharmaceutical Fentanyl-Related Deaths--Multiple States, April 2005-March 2007
  
• THE COVER: West Church, Boston
  
• A PIECE OF MY MIND: The Physician in Winter
  
• POETRY AND MEDICINE: Seasons of Aging
  
• JAMA 100 YEARS AGO: THE PRESENT PANDEMIC OF PLAGUE.
  
• BOOK AND MEDIA REVIEWS: Essential Infectious Disease Topics for Primary Care
  
• BOOK AND MEDIA REVIEWS: Infectious Disease Surveillance
  
• BOOK AND MEDIA REVIEWS: Living Donor Organ Transplantation
  
• BOOK AND MEDIA REVIEWS: Raj's Practical Management of Pain
  
• BOOK AND MEDIA REVIEWS: Implementing an Electronic Medical Record System: Successes, Failures, Lessons
  
• BOOK AND MEDIA REVIEWS: Breathing the Fire: Fighting to Report--and Survive--the War in Iraq
  
• JAMA PATIENT PAGE: Mild Cognitive Impairment
  
• ABOUT THIS JOURNAL: About This Journal